Glyburide or Insulin for Gestational Diabetes?

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Neonatal adiposity following maternal treatment of gestational diabetes with glyburide compared with insulin, by Kristine Y. Lain and colleagues. American Journal of Obstetrics & Gynecology 200:501.e1–501.e6, 2009

What is the problem and what is known about it so far?

Women who have high blood glucose that is discovered for the first time during pregnancy are said to have gestational diabetes mellitus (GDM). Women with GDM are not able to make or use all the insulin their bodies need during pregnancy. About 4% of all pregnant women get GDM. If left untreated, GDM can harm pregnant women and their developing fetuses. However, treatment can greatly lower the risks associated with GDM. Treatment always includes special meal plans and exercise, but for about half of GDM patients, pills or insulin is also needed. Doctors have more experience treating GDM with insulin, but using pills instead could be easier, cheaper, and result in fewer side effects. Some studies have shown that the weight and size of babies born to mothers with GDM do not differ much between mothers who used the diabetes pill glyburide and those that used insulin during pregnancy. But few studies have looked at more specific factors such as babies' body fat levels and markers of metabolic problems in the blood and how these factors may differ between babies whose mothers used glyburide and those whose mothers used insulin during pregnancy.

Why did the researchers do this particular study?

The researchers wanted to find out if there were differences in body fat and metabolic markers between babies whose mothers used glyburide and those whose mothers used insulin to treat GDM.

Who was studied?

The study included 82 babies of mothers who had GDM during pregnancy and who were treated with either glyburide or insulin.

How was the study done?

The researchers measured the babies' body fat levels and performed blood tests and then compared the results between the two groups. 

What did the researchers find?

The babies from both groups had similar body fat and blood test results regardless of which type of GDM treatment their mothers used.

What were the limitations of the study?

The study was small, which may have affected the results. Also, the study involved multiple health care providers, which could have introduced differences such as timing of deliveries, whether the deliveries were induced, and how babies were delivered, all of which could have affected some results. Finally, the few differences that were found between the two treatments may diminish further as physicians gain more experience with glyburide.

What are the implications of the study?

This study suggests that GDM treatment with glyburide may be a safe alternative to insulin. However, more and larger studies are needed to fully compare the two treatments.

FOR MORE INFORMATION

Gestational Diabetes

Diabetes and Pregnancy

Gestational Diabetes: What to Expect