Denice Feig, MD
What are the relative benefits and risks for mother and infant of treatment of gestational diabetes mellitus (GDM) with oral diabetes agents or insulin?
Included studies compared oral diabetes agents with insulin in pregnant women with GDM diagnosed by an oral glucose tolerance test. Maternal and neonatal outcomes were assessed.
MEDLINE, EMBASE/Excerpta Medica, Cochrane Central Register of Controlled Trials, and CINAHL (to Jan 2007); journals (Aug 2006 to May 2008); and references were searched for English-language, randomized, controlled trials (RCTs) and observational studies. 4 RCTs (n = 1248, mean age 26 to 33 y) and 5 cohort studies (n = 831) met the selection criteria.
The Table summarizes results for maternal and neonatal outcomes from individual RCTs. Meta-analysis was done only for birthweight data.
Evidence from randomized trials does not show consistent differences in maternal or neonatal outcomes between oral diabetes agents and insulin for treatment of gestational diabetes.
Oral diabetes agents (glyburide, acarbose, or metformin) vs insulin for gestational diabetes
*Glyburide vs insulin, n = 404.
†Glyburide vs insulin, n = 23.
‡Metformin vs insulin, n = 733.
§Glyburide vs acarbose vs insulin, n = 70.
Feig D. Review: Oral drugs for gestational diabetes do not increase adverse maternal and neonatal outcomes more than insulin. Ann Intern Med. ;150:JC4–9. doi: 10.7326/0003-4819-150-8-200904210-02009
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Published: Ann Intern Med. 2009;150(8):JC4-9.
Cardiology, Coronary Risk Factors, Diabetes, Endocrine and Metabolism.
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