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Glyburide Vs Insulin Gestational Diabetes

Glyburide Associated With More Risk Of Adverse Events Than Insulin In Newborns

Glyburide Associated With More Risk Of Adverse Events Than Insulin In Newborns

Follow all of ScienceDaily's latest research news and top science headlines ! Glyburide associated with more risk of adverse events than insulin in newborns The medication glyburide, which has been increasingly used to treat gestational diabetes in pregnant women, was associated with higher risk for newborns to be admitted to a neonatal intensive care unit, have respiratory distress, hypoglycemia (low blood glucose), birth injury and be large for gestational age compared with infants born to women treated with insulin, according to a new article. The medication glyburide, which has been increasingly used to treat gestational diabetes in pregnant women, was associated with higher risk for newborns to be admitted to a neonatal intensive care unit, have respiratory distress, hypoglycemia (low blood glucose), birth injury and be large for gestational age compared with infants born to women treated with insulin, according to an article published online by JAMA Pediatrics. The prevalence of gestational diabetes mellitus (GDM) in the United States has more than doubled during the last 20 years. Given the widespread and rapid use of glyburide in the last decade more evaluation of the comparative safety and effectiveness of the drug is needed. Previous literature on the association between treatment with glyburide and adverse neonatal outcomes is limited, according to background in the study. Wendy Camelo Castillo, Ph.D., of the University of Maryland, Baltimore, and Michele Jonsson Funk, Ph.D., of the University of North Carolina at Chapel Hill, and coauthors estimated the risk of adverse maternal and neonatal outcomes in women with GDM treated with glyburide vs. insulin using data from a nationwide employer-based insurance claims database from 2000 through 2011. The authors e Continue reading >>

Adverse Pregnancy Outcomes With Glyburide Vs. Insulin In Women With Gestational Diabetes

Adverse Pregnancy Outcomes With Glyburide Vs. Insulin In Women With Gestational Diabetes

Adverse pregnancy outcomes with glyburide vs. insulin in women with gestational diabetes Adverse pregnancy outcomes with glyburide vs. insulin in women with gestational diabetes Researchers conducted a retrospective cohort study to estimate the risk of adverse maternal and neonatal outcomes in women with gestational diabetes mellitus (GDM) who were treated with glyburide compared with insulin. The study included 9,173 U.S. women, aged 15–45 years, with GDM who were treated with glyburide or insulin. Researchers conducted a retrospective cohort study to estimate the risk of adverse maternal and neonatal outcomes in women with gestational diabetes mellitus (GDM) who were treated with glyburide compared with insulin. The study included 9,173 U.S. women, aged 1545 years, with GDM who were treated with glyburide or insulin. Newborns of women treated with glyburide were at higher risk for neonatal ICU admission, respiratory distress, hypoglycemia, birth injury, and larger gestational age compared with those treated with insulin. However, newborns of women treated with glyburide were not at increased risk for obstetric trauma, preterm birth, or jaundice. Risk of cesarean delivery was 3% lower in the glyburide group. Because newborns from mothers treated with glyburide were more likely to experience adverse outcomes, the researchers recommend further investigation of these differences in pregnancy outcomes. Continue reading >>

The Effectiveness Of Glyburide Compared To Insulin In The Management Of Gestational Diabetes Mellitus: A Systematic Review

The Effectiveness Of Glyburide Compared To Insulin In The Management Of Gestational Diabetes Mellitus: A Systematic Review

The Effectiveness of Glyburide Compared to Insulin in the Management of Gestational Diabetes Mellitus: A Systematic Review Download as PDF (Size:3071KB) PP. 58-66 DOI: 10.4236/jdm.2015.52007 2,493 Downloads 3,026 Views Citations Background: Insulin therapy has been themainstay in managing women with gestational diabetes mellitus (GDM), but somedisadvantages of insulin have led to the use of glyburide, which is inexpensive in some countries, to manage GDM. However, there has been debate overits effectiveness, efficacy and safety when compared to insulin for maternalglycaemic control, and some adverse neonatal outcomes in GDM. Method: Asystematic review of eight randomised controlled trial (RCT) studies was undertakento compare glyburide and insulin. Studies involving 849 participants wereincluded in the quantitative analysis. Results: There was no significantdifference between glyburide and insulin in maternal fasting (P = 0.09; SMD:0.13; 95% CI: 0.02 to 0.28) and postprandial (P = 0.45; SMD: 0.05; 95% CI: 0.09 to 0.19) glycaemic control and glycosylated hae-moglobin (P = 0.35; SMD:0.08; 95% CI: 0.08 to 0.24). When compared with insulin, glyburide had anincrease risk ratio (RR) for neonatal hypoglycaemia (P = 0.0002; RR: 2.27; 95%CI: 1.47 to 3.51) and large for gestational age babies (P = 0.03; RR: 1.60; 95%CI: 1.06 to 2.41). Estimation of standard mean difference shows that neonatalbirth weight was significantly higher in subjects receiving glyburide than inthe insulin group (P = 0.002; SMD: 0.21; 95% CI: 0.08 to 0.35). Conclusions:Glyburide was seen to be clinically effective and a safer alternative toinsulin for maternal glycaemic control in GDM women. It is affordable,convenient and requires no comprehensive educative training at the time ofinitiation of therapy. Ho Continue reading >>

Association Of Adverse Pregnancy Outcomes With Glyburide Vs Insulin In Women With Gestational Diabetes

Association Of Adverse Pregnancy Outcomes With Glyburide Vs Insulin In Women With Gestational Diabetes

Aims/introduction: This study aimed to estimate the prevalence of gestational diabetes mellitus (GDM) and use of anti-diabetic medications for patients with GDM in Korea, using data of the period 2007-2011 from the Health Insurance Review and Assessment (HIRA) database, which includes the claims data of 97% of the Korean population.Materials and methods: We used the Healthcare Common Procedure Coding System codes provided by the HIRA to identify women with delivery in the HIRA database between 2009 and 2011. GDM was defined according to ICD-10 codes, and patients with pre-existing diabetes between January 1, 2007 and pregnancy were excluded. A Poisson regression was performed to evaluate the trends in annual prevalence rates.Results: The annual numbers of deliveries in 2009-2011 were 479,160 in 2009, 449,747 in 2010, and 377,374 in 2011. The prevalence of GDM during that period was 7.5% in 2009-2011: 5.7% in 2009, 7.8% in 2010, and 9.5% in 2011. The age-stratified analysis showed that the prevalence of GDM was highest in women aged 40-44 years, at 10.6% in 2009-2011, and that the annual prevalence significantly increased even in young women aged 20-29 years during that period (P < 0.05). More than 95% of the patients with GDM did not take any anti-diabetic medication. Among the anti-diabetic medications prescribed for patients with GDM, insulin was most commonly prescribed (for >98% of the patients with GDM on medication).Conclusions: The prevalence of GDM in Korean women recently reached 5.7-9.5% in recent years. This represents a public health concern that warrants proper screening and medical care for GDM in women during the childbearing years. Approximately 90% of diabetes cases in pregnant women are considered gestational diabetes mellitus (GDM). It is well known Continue reading >>

Women With Gestational Diabetes May Do Best With Metformin And Glyburide Combo

Women With Gestational Diabetes May Do Best With Metformin And Glyburide Combo

A study recently published it the American Diabetes Association’s Diabetes Care journal found that the combination of metformin and glyburide lead to fewer women with gestational diabetes needing insulin after pregnancy when compared to taking just one of the drugs. Researchers sought to find out how effective and safe metformin was compared to glyburide and how well the two worked in a combined treatment for gestational diabetes. Metformin is the first-line treatment for type 2 diabetes which helps increase insulin sensitivity and stops some of the liver’s secretion of glucose. Glyburide is a sulfonylurea which helps to stimulate the increase of insulin in the body. Gestational diabetes is when blood sugar levels rise during pregnancy. Gestational diabetes often leads to type 2 diabetes within the following decade. Researchers conducted a prospective randomized controlled study where they randomly assigned women with gestational diabetes at 13-33 weeks gestation and whose blood sugar levels were inadequately managed by diet to take either metformin or glyburide. If any of the women didn’t have optimal blood sugars, they took the combination of the two drugs. In the case of adverse effects, the women took a different drug and if both didn’t work, then insulin was provided. The researchers looked for the rate of treatment failure and blood sugar management after the first medication was given by checking mean daily blood sugar charts. So Which Medication Worked Best? Glyburide was started in 53 patients. The drug failed in 18 patients due to low blood sugar in 6 patients and a lack of blood sugar control in 12 patients. Metformin was started in 51 patients and failed in 15 patients due to gastrointestinal side effects in one patient a lack of glycemic control in Continue reading >>

Gestational Diabetes: What Are The Effects Of Glyburide And Metformin?

Gestational Diabetes: What Are The Effects Of Glyburide And Metformin?

With the rising popularity of oral hypoglycemic agents for treating gestational diabetes, a study compared the efficacy and safety of treating gestational diabetes with glyburide versus metformin and their combination. Oral hypoglycemic agents are now an acceptable option in guidelines for treating gestational diabetes mellitus (GDM) since studies have demonstrated metformin and glyburide as appropriate alternatives to insulin. Not only did a meta-analysis show similar efficacy and safety compared to insulin, but oral hypoglycemic agents are also easier to administer and lower in cost, which makes them a more attractive option and increases patient compliance. However, previous studies comparing glyburide and metformin have conflicting results. Thus, researchers sought to evaluate glyburide versus metformin and their combination in treating GDM. published in Diabetes Care, researchers in Israel compared glyburide versus metformin in GDM treatment and evaluated glycemic control after switching or adding a second oral hypoglycemic drug in the case that the first one failed. The study recruited women between the ages 18 and 45 years that were diagnosed with GDM between 13 and 33 weeks of gestation and who had poor glucose control with diet alone, thus requiring medical therapy. Patients were randomly allocated to receive either glyburide or metformin with individualized dosing according to their daily glucose chart values as assessed by the GDM clinic physician. If the first treatment failed, the other oral hypoglycemic agent was either added to it in the case of poor glycemic control, or replaced it in the case of discontinuation due to adverse effects. Third-line therapy with insulin was started if the second-line therapy failed. The study started with 53 patients initi Continue reading >>

Gestational Diabetes - Insulin Vs Glyburide?

Gestational Diabetes - Insulin Vs Glyburide?

Gestational Diabetes - Insulin vs Glyburide? I am pregnant with my 2nd child and had gestational diabetes with my first. I expected to get it again, but not being overweight I thought it would be later in pregnancy. Unfortunately I already have it and am only 18 weeks. I found out around 14-15 weeks. The diet did not help so my doctor put me on Glyburide which I used for my first pregnancy but had a lot of problems with. I am having very low blood sugar (37 the other morning!) and don't like the constant up and down. I wasn't working during my first pregnancy and am now, and also have a child to take care of so constantly trying to deal with the ups and downs is a little harder on me than last time. My docotor stated that insulin would be better, but of course I have never given my shots and am scared to do so. Just wondering if anyone else has had to go that route and how was it, any advice. It is very tempting so that I don't have to constantly go get a snack in the middle of the night. Thanks! Yes want to add that I follow my diet to a tee (saw a dietician the last time and following that same diet)....only gained 10 lbs with the first child and so far am down 2 pounds and probably won't gain until the end since I am on the diet (the goal is to gain weight but what happened last time is that any and all fat that I did have melted off of me before I started gaining and the baby weighed 7 lb 9 oz and delivered at 40 weeks)....unfortunately when I exercize it doesn't effect my sugar at all...definitely doing both but not seeing the results and my doctor is baffled since this is usually only typical in an overweight person. I am 28 years old. Continue reading >>

Glyburide As Effective As Insulin For Gestational Diabetes [classics Series]

Glyburide As Effective As Insulin For Gestational Diabetes [classics Series]

1. Among women with gestational diabetes requiring treatment, those randomized to glyburide achieved similar glycemic control to women in the insulin control group. Original Date of Publication: October 2000 Study Rundown: The adverse pregnancy outcomes associated with diabetes have been well documented. Following diagnosis, women with gestational diabetes mellitus are initially managed with dietary therapy, termed modified nutritional therapy (MNT). If glycemic control is not achieved with MNT, the next step in treatment is the initiation of insulin therapy. Insulin is well-studied in pregnancy and known to be highly effective and safe. Yet, insulin is an expensive and onerous treatment that can be cumbersome to learn, inconvenient and difficult to adhere to, and painful for patients. Oral agents are a well-established treatment for insulin-dependent diabetes outside of pregnancy. They have been infrequently used in pregnancy, however, due to demonstrated risks of neonatal hypoglycemia associated with early-generation sulfonylurea drugs and metformin, both of which cross the placenta. Sulfonylurea drugs improve glycemic control by increasing insulin secretion, which decreases hepatic glucose production and thereby indirectly improves insulin sensitivity. Subsequent to these investigations, however, newer oral hypoglycemic agents were developed, including glyburide. Study authors of the present work investigated the pharmacologic profile of glyburide in pregnant women and found that glyburide does not cross the human placenta in any meaningful concentration. Given this low likelihood that glyburide crosses the placenta and the mild degree of hyperglycemia affecting most women with gestational diabetes, authors postulated that treatment with glyburide might achieve glyce Continue reading >>

Tips From Other Journals - American Family Physician

Tips From Other Journals - American Family Physician

Glyburide vs. Insulin Therapy in Women with Gestational Diabetes Am Fam Physician.2006Apr1;73(7):1266-1270. Approximately 2 to 5 percent of pregnant women will develop gestational diabetes mellitus, leading to a significant increase in maternal and neonatal morbidity and mortality. In the past, the first-line therapy for gestational diabetes after failure of diet control was insulin. In one study, researchers found that glyburide (Micronase) was as clinically effective as insulin in treating patients with gestational diabetes. Despite these results, and that recent expert opinion has recommended glyburide as an alternative treatment, only 13 percent of physicians in a 2003 study reported using this medication as first-line therapy. Jacobson and associates evaluated the use of glyburide versus insulin in the treatment of women with gestational diabetes mellitus that has been unresponsive to diet therapy. A retrospective chart audit of women with gestational diabetes who required medication for control was performed for two years before the introduction of a glyburide protocol and for two years after the protocol was used. The participants were women with singleton pregnancies diagnosed with gestational diabetes between 12 and 34 weeks of gestation and who met the criteria on a three-hour glucose tolerance test established by the National Diabetes Data Group. Women were excluded from the study if their fasting blood glucose level was more than 140 mg per dL (7.77 mmol per L). All of the participants were enrolled in a major prepaid group model managed care organization and were provided with nutritional counseling and instruction on glucose self-monitoring. Patients treated with glyburide were started at a dosage of 2.5 mg daily with their morning meal. If glycemic contr Continue reading >>

Assistant Professor, Department Of Pharmacy Practice

Assistant Professor, Department Of Pharmacy Practice

Jennifer Elliott PharmD, CDE Assistant Professor, Department of Pharmacy Practice Philadelphia College of Osteopathic Medicine Georgia Campus School of Pharmacy Suwanee, Georgia Sara (Mandy) Reece PharmD, CDE, BC-ADM Assistant Professor and Vice Chair, Department of Pharmacy Practice Philadelphia College of Osteopathic Medicine Georgia Campus School of Pharmacy Suwanee, Georgia Disclosure to Participants • Notice of Requirements For Successful Completion – Please refer to learning goals and objectives – Learners must attend the full activity and complete the evaluation in order to claim continuing education credit/hours • Conflict of Interest (COI) and Financial Relationship Disclosures: – None to report • Non-Endorsement of Products: – Accredited status does not imply endorsement by AADE, ANCC, ACPE or CDR of any commercial products displayed in conjunction with this educational activity • Off-Label Use: – Participants will be notified by speakers to any product used for a purpose other than for which it was approved by the Food and Drug Administration. Oral Anti-hyperglycemic and Insulin Therapies in Pregnancy Learning Objectives • Discuss current guidelines for treatment of pregestational and gestational diabetes • Discuss current evidence-based literature for insulin therapies, and oral antihyperglycemics during pregnancy • Apply evidence based approaches to patient scenarios 8/6/2015 2 Introduction • Diabetes During Pregnancy1 – Gestational Diabetes Mellitus (GDM) – Preexisting Type 1 or Type 2 Diabetes Mellitus Treatment Guidelines • Glycemic Targets in Pregnancy1 – GDM • Preprandial ≤ 95 mg/dL and either • 1-hour postprandial ≤ 140 Continue reading >>

Gestational Diabetes Drug Used In Pregnancy May Raise Babies Risk For Complications

Gestational Diabetes Drug Used In Pregnancy May Raise Babies Risk For Complications

A study published March 30 in JAMA Pediatrics links the use of glyburide in mothers with Gestational Diabetes Mellitus (GDM) to more infant complications including increased visits to the intensive care unit and respiratory distress. Glyburide (DiaBeta) is an oral tablet that patients prefer over injections of insulin to control blood sugar levels in gestational diabetes. During the last ten years there has been increasing use of glyburide (DiaBeta) in mothers with gestational diabetes. The research was conducted using a nationwide, employer-based insurance database. Data was collected on more than 110,000 women with gestational diabetes, during the study period of 2000-2011. According to the study, about 8 percent of women with gestational diabetes were treated with glyburide or insulin. Researchers found the use of glyburide increased from 8.5 percent to 64 percent during the study period. Infants born to mothers who were given glyburide (DiaBeta) during pregnancy had a higher risk of having low blood sugar, being too large at birth, had a higher risk of birth injury and had a higher risk of respiratory distress needing intensive care compared to babies born to mothers treated with insulin. "Doctors and patients need to be aware that although glyburide is easier to use than insulin, not all women may be good candidates for management with this medication," said lead researcher Michele Jonsson Funk, an assistant professor of epidemiology at the University of North Carolina at Chapel Hill. "We need to better understand which women can be treated effectively with glyburide, considering not only the short-term but also the long-term effects that these treatments may have on the health of their newborns," she said. Funk added that exactly why the drug is linked with these Continue reading >>

Association Of Adverse Pregnancy Outcomes With Glyburide Vs Insulin In Women With Gestational Diabetes.

Association Of Adverse Pregnancy Outcomes With Glyburide Vs Insulin In Women With Gestational Diabetes.

JAMA Pediatr. 2015 May;169(5):452-8. doi: 10.1001/jamapediatrics.2015.74. Association of Adverse Pregnancy Outcomes With Glyburide vs Insulin in Women With Gestational Diabetes. Department of Pharmaceutical Health Services Research, School of Pharmacy, University of Maryland, Baltimore2Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill. Department of Obstetrics and Gynecology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill. Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill. Department of Pediatrics, Duke University, Durham, North Carolina. Glyburide is thought to be safe for use during pregnancy for treatment of gestational diabetes mellitus (GDM). However, there are limited data on the effectiveness of glyburide when compared with insulin as used in a real-world setting. To estimate the risk of adverse maternal and neonatal outcomes in women with GDM treated with glyburide compared with insulin. Retrospective cohort study of a population-based cohort from a nationwide US employer-based insurance claims database from January 1, 2000, to December 31, 2011. We identified women with GDM and their newborns. We excluded those with type 1 or 2 diabetes and those younger than 15 years or older than 45 years. Treatment with glyburide or insulin during pregnancy within 150 days before delivery. We used binomial regression to estimate risk ratios (RRs) and risk differences with 95% confidence intervals for the association of glyburide with diagnosis codes for obstetric trauma, cesarean delivery, birth injury, preterm birth, hypoglycemia, respiratory distress, jaundice, large for gestational age, and h Continue reading >>

12. Management Of Diabetes In Pregnancy

12. Management Of Diabetes In Pregnancy

For guidelines related to the diagnosis of gestational diabetes mellitus, please refer to Section 2 “Classification and Diagnosis of Diabetes.” Pregestational Diabetes Provide preconception counseling that addresses the importance of glycemic control as close to normal as is safely possible, ideally A1C <6.5% (48 mmol/mol), to reduce the risk of congenital anomalies. B Family planning should be discussed and effective contraception should be prescribed and used until a woman is prepared and ready to become pregnant. A Women with preexisting type 1 or type 2 diabetes who are planning pregnancy or who have become pregnant should be counseled on the risk of development and/or progression of diabetic retinopathy. Eye examinations should occur before pregnancy or in the first trimester and then be monitored every trimester and for 1 year postpartum as indicated by degree of retinopathy. B Lifestyle change is an essential component of management of gestational diabetes mellitus and may suffice for treatment for many women. Medications should be added if needed to achieve glycemic targets. A Preferred medications in gestational diabetes mellitus are insulin and metformin; glyburide may be used but may have a higher rate of neonatal hypoglycemia and macrosomia than insulin or metformin. Other agents have not been adequately studied. Most oral agents cross the placenta, and all lack long-term safety data. A General Principles for Management of Diabetes in Pregnancy Potentially teratogenic medications (ACE inhibitors, statins, etc.) should be avoided in sexually active women of childbearing age who are not using reliable contraception. B Fasting, preprandial, and postprandial self-monitoring of blood glucose are recommended in both gestational diabetes mellitus and pregestati Continue reading >>

Metformin In Gestational Diabetes

Metformin In Gestational Diabetes

Home / Conditions / Gestational Diabetes / Metformin in Gestational Diabetes Should metformin or glyburide, or a combination of both drugs, be the first-line treatment for gestational diabetes? Uncontrolled hyperglycemia during pregnancy is known to affect fetal development and increase the prevalence of gestational diabetes mellitus (GDM) that complicates 5-7% of pregnancies. Studies show that routine care including healthy diet, physical activity, and glucose monitoring may not be adequate to achieve glucose control in those pregnant women. Although, previously US Food and Drug Administration (FDA) had approved insulin as the only treatment for GDM, ongoing studies have shown promising results with oral hypoglycemic drugs: Glyburide and Metformin are cost effective, therapeutically efficacious, easy to administer, and safe pharmacological treatment options for GDM. In a prospective, open-labeled, randomized, parallel study, women at 1333 weeks of gestation diagnosed with GDM, between the ages of 1845 years were recruited to compare the efficacy and safety of glyburide versus metformin in the treatment of GDM. Also, the improvement in glycemic control after their replacement due to adverse effects or after adding the second drug due to failure of the first were also evaluated. Pharmacotherapy was initiated in subjects with either fasting blood glucose (BG) >95 mg/dL, a 1.5-h postprandial of >130 mg/dL, or a daily average >100 mg/dL after at least a week of dietary treatment. Subjects underwent a sonographic dating of the pregnancy earlier than 24 weeks and signed a consent form. The study hypothesized that GDM is one of the chief conditions that contributes to obstetrical complications and prenatal morbidity and that they can be improved with glycemic control by impro Continue reading >>

Neonatal Hypoglycemia Rates In Glyburide Vs Insulin Treatment For Gestational Diabetes

Neonatal Hypoglycemia Rates In Glyburide Vs Insulin Treatment For Gestational Diabetes

Neonatal Hypoglycemia Rates in Glyburide vs Insulin Treatment for Gestational Diabetes Neonatal Hypoglycemia Rates in Glyburide vs Insulin Treatment for Gestational Diabetes No differences in short-term maternal outcomes were noted between the different treatments. Glyburide and insulin are equally effective for treating women with gestational diabetes, according to a meta-analysis published in PLoS ONE.1 However, incidence of neonatal hypoglycemia was greater among infants whose mothers used glyburide vs insulin. Researchers from Shanghai Jiaotong University School of Medicine Xinhua Hospital in Shanghai, China, reviewed 3 large databases and examined 10 randomized controlled trials that met study inclusion criteria. Of all women with gestational diabetes (n=1194), 575 used glyburide and 619 used insulin. Maternal glycemic control was not significantly different between the 2 treatment groups. Data analysis revealed a greater risk for any neonatal hypoglycemia after treatment with glyburide than with insulin (risk ratio [RR], 1.89; 95% CI, 1.26-2.82; P =.002). Sensitivity analysis confirmed the robustness of the result (RR, 2.29; 95% CI, 1.49-3.54; P =.0002). Neonatal hypoglycemia (blood glucose <40 mg/dL) occurred more often in the glyburide group than in the insulin group (RR, 1.89; 95% CI, 1.26-2.82; P =.002), although neither difference reached statistical significance. Continue reading >>

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