USA: Researchers in a recent study report that their findings does not provide evidence of a difference in perinatal outcomes among gestational diabetes (GDM) patients initiating glyburide compared to insulin initiaiton. The study appears in JAMA Network Open.
"Glyburide is not recommended as a first-line medication for GDM treatment given the current guidelines of the ADA and the ACOG," Monique M. Hedderson, Division of Research, Kaiser Permanente Northern California, Oakland, and colleagues wrote in their study. "However, there is an uregent need for future work that investigated the long-term safety outcomes for women and children exposed to the different GDM treatment regimens (insulin, glyburide, and metofmrin)."

Women with gestaional diabetes do not achieve blood sugar control alone with lifestyle modification and needs medication treatment. Oral agents, such as glyburide, have several advantages compared to insulin for GDM treatment. Advantages include greater patient acceptance; however, there remains controversy on the glyburide effectiveness for GDM treatment.
Against the above background, Dr. Hedderson and colleagues aimed to compare the perinatal and neonatal outcomes associated with glyburide vs insulin using causal inference methods in a clinical setting with information on glycemic control in an population-based cohort study.
The study included GDM patients who required medication treatment from 2007 to 2017 in Kaiser Permanente Northern California. Associations of exposure to glyburide vs insulin with perinatal outcomes were evaluated using machine learning and rigorous casual inference methods. Data analysis was conducted from March 2018 to July 2017.
Outcomes evaluated separately included neonatal hypoglycemia, jaundice, respiratory distress syndrome (RDS), shoulder dystocia, neonatal intensive care unit (NICU) admission, size-for–gestational age, and cesarean delivery. Perinatal outcomes were compared separately between those initiating glyburide and insulin by using inverse probability weighting (IPW) estimation. This was combined with Super Learning for propensity score estimation to account for both baseline and time-dependent confounding in both per-protocol (primary) and intention-to-treat (secondary) analyses for evaluating sustained exposure to the same therapy.
The study revealed the following findings:
11 321 patients with GDM (mean age, 32.9 years) initiated glyburide or insulin during pregnancy from 2007 to 2017.
In multivariate models, the risk of neonatal respiratory distress was 2.03 per 100 births lower and the risk of NICU admission was 3.32 per 100 births lower after continuous exposure to glyburide compared with insulin.
There were no statistically significant differences in glyburide vs insulin initiation in risk for neonatal hypoglycemia (0.85 per 100 births), jaundice (0.02 per 100 births), shoulder dystocia (−1.05 per 100 births), or large-for–gestational age categories (−2.75 per 100 births).
"Our findings do not provide evidence of a difference in the outcomes examined between patients with GDM initiating glyburide compared with those initiating insulin," concluded the authors.
Reference:
Hedderson MM, Badon SE, Pimentel N, et al. Association of Glyburide and Subcutaneous Insulin With Perinatal Complications Among Women With Gestational Diabetes. JAMA Netw Open. 2022;5(3):e225026. doi:10.1001/jamanetworkopen.2022.5026