Glibenclamide, metformin, and insulin for the treatment of gestational diabetes: a systematic review and meta-analysis

Montserrat Balsells, Apolonia García-Patterson, Ivan Solà, Marta Roqué, Ignasi Gich, Rosa Corcoy, Montserrat Balsells, Apolonia García-Patterson, Ivan Solà, Marta Roqué, Ignasi Gich, Rosa Corcoy

Abstract

Objective: To summarize short term outcomes in randomized controlled trials comparing glibenclamide or metformin versus insulin or versus each other in women with gestational diabetes requiring drug treatment.

Design: Systematic review and meta-analysis.

Eligibility criteria for selecting studies: Randomized controlled trials that fulfilled all the following: (1) published as full text; (2) addressed women with gestational diabetes requiring drug treatment; (3) compared glibenclamide v insulin, metformin v insulin, or metformin v glibenclamide; and (4) provided information on maternal or fetal outcomes.

Data sources: Medline, CENTRAL, and Embase were searched up to 20 May 2014.

Outcomes measures: We considered 14 primary outcomes (6 maternal, 8 fetal) and 16 secondary (5 maternal, 11 fetal) outcomes.

Results: We analyzed 15 articles, including 2509 subjects. Significant differences for primary outcomes in glibenclamide v insulin were obtained in birth weight (mean difference 109 g (95% confidence interval 35.9 to 181)), macrosomia (risk ratio 2.62 (1.35 to 5.08)), and neonatal hypoglycaemia (risk ratio 2.04 (1.30 to 3.20)). In metformin v insulin, significance was reached for maternal weight gain (mean difference -1.14 kg (-2.22 to -0.06)), gestational age at delivery (mean difference -0.16 weeks (-0.30 to -0.02)), and preterm birth (risk ratio 1.50 (1.04 to 2.16)), with a trend for neonatal hypoglycaemia (risk ratio 0.78 (0.60 to 1.01)). In metformin v glibenclamide, significance was reached for maternal weight gain (mean difference -2.06 kg (-3.98 to -0.14)), birth weight (mean difference -209 g (-314 to -104)), macrosomia (risk ratio 0.33 (0.13 to 0.81)), and large for gestational age newborn (risk ratio 0.44 (0.21 to 0.92)). Four secondary outcomes were better for metformin in metformin v insulin, and one was worse for metformin in metformin v glibenclamide. Treatment failure was higher with metformin than with glibenclamide.

Conclusions: At short term, in women with gestational diabetes requiring drug treatment, glibenclamide is clearly inferior to both insulin and metformin, while metformin (plus insulin when required) performs slightly better than insulin. According to these results, glibenclamide should not be used for the treatment of women with gestational diabetes if insulin or metformin is available.Systematic review registration NCT01998113.

Conflict of interest statement

Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: declare no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years, though MB, AGP, and RC have received travel grants from Lilly, NovoNordisk, and Sanofi Aventis; and no other relationships or activities that could appear to have influenced the submitted work.

© Balsells et al 2015.

Figures

https://www.ncbi.nlm.nih.gov/pmc/articles/instance/4793990/bin/balm021840.f1_default.jpg
Fig 1 Forest plots of birth weight in the meta-analyses comparing glibenclamide and metformin with insulin or with each other in women with gestational diabetes
https://www.ncbi.nlm.nih.gov/pmc/articles/instance/4793990/bin/balm021840.f2_default.jpg
Fig 2 Forest plots of any neonatal hypoglycaemia in the meta-analyses comparing glibenclamide and metformin with insulin or with each other in women with gestational diabetes

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