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Nachum, Z., et al, Diab Care 40(3):332, March 2017
METHODS: These Israeli authors performed an open-label trial of the efficacy and safety of glyburide, metformin and their combination for gestational diabetes mellitus (GDM). The study included 104 women aged 18-45 (mean age, 33) with elevated blood glucose due to GDM diagnosed at 13-33 weeks’ gestation who were randomized to begin treatment with glyburide or metformin. Treatment was changed as follows: the patient was switched to the other drug in case of adverse events, changed to combination therapy in the event of treatment failure (preprandial glucose above 95mg/dL, postprandial glucose above 130mg/dL, or daily glucose above 100mg/dL), changed to insulin if both drugs failed. The primary outcome was treatment failure (adverse events or poor glycemic control) after the first study drug based on patients’ daily glucose charts.
RESULTS: Treatment failed in 18 glyburide patients (34%) and 15 metformin patients (29%), a nonsignificant difference (p=0.6). Failure with glyburide was due to hypoglycemia in 11% and poor glycemic control in 23%; metformin failure was due to gastrointestinal events in 2% and poor glycemic control in 28%. Second-line treatment with metformin was more effective than second-line glyburide (87% versus 50%; p=0.03), and glyburide patients were more likely to require insulin (17% versus 4%; p=0.03). Combining the drugs reduced the need for insulin from 32% to 11% (p=0.0002). Safety parameters and obstetric outcomes were similar between groups.
CONCLUSIONS: In this study, glyburide and metformin were generally comparable in efficacy and safety for treating GDM. There may be a slight advantage to starting with metformin. Combining the two agents reduced the risk of treatment failure and the need for insulin. 22 references ( enavy1@gmail.com – no reprints)