Safety of glyburide and insulin in the treatment of gestational diabetes mellitus: a meta-analysis
LIU Jinlong1,2, ZHANG Yan3, HOU Haiyan3, WANG Chao4, CHANG Yu3, CHEN Xiao3
1.Postgraduate Team of Logistics College of Chinese People’s Armed Police Force, Tianjin 300162, China; 2. Hospital of Army 31696, Jinzhou 121000, China; 3. Department of Obstetrics and Gynecology, Featured Medical Center of Chinese People’s Armed Police Force, Tianjin 300162,China; 4. Hospital of Army 32296, Shenyang 110101, China
Abstract：Objective To systematically evaluate the safety of glyburide and insulin in the treatment of gestational diabetes mellitus in order to provide reference for clinical treatment.Methods Related articles were retrieved from CNKI, CBM, WanFang Database, Embase, Cochrane and PubMed from inception to November of 2018. Randomized controlled trials were collected in strict accordance with the inclusion and exclusion criteria. Two reviewers independently screened the literature. Endnote X8 was adopted to select eligible literature and data was extracted for quality assessment. RevMan 5.3 software was used for meta-analysis and descriptive statistical analysis. Outcome indicators included in this study were calculated.Results A total of 2115 patients were enrolled in seven randomized controlled trials. A total of six outcome indicators were analyzed. Meta-analysis showed that compared with the insulin group, the proportion of neonatal hypoglycemia was significantly increased in the glyburide group (OR=1.93, 95% CI=1.10-3.39), but there was no statistically significant difference in macrosomia (OR=0.89, 95% CI=0.68-1.17), the number of newborns admitted to the neonatal intensive care unit(OR=0.71, 95% CI=0.44-1.14), premature delivery (OR=1.26, 95%CI=0.88-1.99), neonatal hyperbilirubinemia (OR=0.77, 95% CI=0.52-1.16) or the number of cases of cesarean section (OR=0.87, 95% CI=0.67-1.13).Conclusion Studies of pregnant women with gestational diabetes have shown that there is no significant difference in safety between glyburide and insulin therapies as long as neonatal hypoglycemia is detected without delay.
Farrar D. Hyperglycemia in pregnancy: prevalence, impact, and management challenges[J]. Int J Womens Health, 2016,8:519-527.
[2]
Krejcí H. Gestational diabetes mellitus[J]. Vnitr Lek, 2016,62(11 Suppl 4):S52-61.
[3]
Gui J, Liu Q, Feng L. Metformin vs insulin in the management of gestational diabetes: a meta-analysis[J]. PLoS One, 2013,8(5):e64585.
[4]
Song R, Chen L, Chen Y, et al. Comparison of glyburide and insulin in the management of gestational diabetes:a meta-analysis[J]. PLoS One, 2017,12(8):e0182488.
[5]
Langer O, Conway D L, Berkus M D, et al. A comparison of glyburide and insulin in women with gestational diabetes mellitus[J]. N Engl J Med, 2000,343(16):1134-1138.
[6]
Committee on Practice Bulletins-Obstetrics. ACOG practice bulletin No. 190: gestational diabetes mellitus[J]. Obstet Gynecol, 2018, 131(2): e49-e64.
[7]
Sénat M V, Affres H, Letourneau A, et al. Effect of glyburide vs subcutaneous insulin on perinatal complications among women with gestational diabetes: a randomized clinical trial[J]. JAMA, 2018,319(17):1773-1780.
[8]
Mirzamoradi M, Heidar Z, Faalpoor Z, et al. Comparison of glyburide and insulin in women with gestational diabetes mellitus and associated perinatal outcome: a randomized clinical trial[J]. Acta Med Iran, 2015,53(2):97-103.
[9]
Koren R, Ashwal E, Hod M, et al. Insulin detemir versus glyburide in women with gestational diabetes mellitus[J]. Gynecol Endocrinol, 2016,32(11):916-919.
Mathews J E, Biswas B, Samuel P,et al. Retrospective cohort study comparing neonatal outcomes of women treated with glyburide or insulin in gestational diabetes: a 5-year experience in a South Indian teaching hospital[J]. Indian J Med Sci, 2011,65(11):476-481.
[13]
Tempe A, Mayanglambam R D. Glyburide as treatment option for gestational diabetes mellitus[J]. J Obstet Gynaecol Res, 2013,39(6):1147-1152.
[14]
Zeng Y C, Li M J, Chen Y, et al. The use of glyburide in the management of gestational diabetes mellitus: a meta-analysis[J]. Adv Med Sci, 2014,59(1):95-101.
[15]
Balsells M, García-Patterson A, Solà I, et al. Glibenclamide, metformin, and insulin for the treatment of gestational diabetes: a systematic review and meta-analysis[J]. BMJ, 2015,350:h102.
[16]
Jiang Y F, Chen X Y, Ding T, et al. Comparative efficacy and safety of OADs in management of GDM: network meta-analysis of randomized controlled trials[J]. J Clin Endocrinol Metab, 2015,100(5):2071-2080.
[17]
Malek R, Davis S N. Pharmacokinetics, efficacy and safety of glyburide for treatment of gestational diabetes mellitus[J]. Expert Opin Drug MetabToxicol, 2016,12(6):691-699.
[18]
Bertini A M, Silva J C, Taborda W, et al. Perinatal outcomes and the use of oral hypoglycemic agents[J]. J Perinat Med, 2005,33(6):519-523.
[19]
Silva J C, Bertini A M, Taborda W, et al. Glibenclamide in the treatment for gestational diabetes mellitus in a compared study to insulin[J]. Arq Bras Endocrinol Metabol, 2007,51(4):541-546.
[20]
McKinlay C J, Alsweiler J M, Ansell J M, et al. Neonatal glycemia and neurodevelopmental outcomes at 2 years[J]. N Engl J Med, 2015,373(16):1507-1518.
[21]
Kimber-Trojnar Z, Marciniak B, Patro-Malysza J, et al. Is glyburide safe in pregnancy?[J]. Curr Pharm Biotechnol, 2014,15(1):100-112.
2019, Vol. 30 
