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Can glyburide be advocated over subcutaneous insulin for perinatal outcomes of women with gestational diabetes? A systematic review and meta-analysis

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Abstract

Purpose

To obtain precise findings from published studies about the efficacy and safety of glyburide versus subcutaneous insulin in patients with gestational diabetes mellitus (GDM).

Methods

We searched PubMed, Cochrane Library, Web of Science, and Scopus, up to January 2019, for relevant studies that compared glyburide with subcutaneous insulin for patients with GDM. We extracted maternal and neonatal outcomes from included studies, performed meta-analysis, evaluated heterogeneity, assessed the risk of bias of included studies, and conducted subgroup and sensitivity analyses.

Results

A total of 24 studies (11 randomized controlled trials (RCTs) and 13 observational cohort studies) with a total of 24,517 women were included in the present study. The pooled estimate showed that glyburide significantly decreased the need for cesarean section (OR = 0.87, 95% CI [0.82, 0.92], p < 0.0001), fasting blood glucose (MD − 5.63 mg/dL, 95% CI [− 10.97, − 0.28], p = 0.04), and Apgar score at 5 min (MD − 0.30, 95% CI [− 0.36, − 0.23], p < 0.001) than insulin. However, glyburide significantly increased the risk of neonatal hypoglycemia (OR = 1.42, 95% CI [1.03, 1.95], p = 0.03) and neonatal intensive care unit admission duration (NICU) (MD 4.26 days, 95% CI [2.65, 5.86], p < 0.01) compared to insulin. The overall results did not favor either group in terms of macrosomia (OR = 1.14, 95% CI [0.92, 1.41], p = 0.25) and large for gestational age (LGA) (OR = 1.38, 95% CI [0.99, 1.92], p = 0.06). While subgroup analysis of RCTs showed that maternal hypoglycemia and LGA rates were significantly higher in glyburide than insulin and cesarean section rates were comparable between both compared groups.

Conclusion

Our study suggests that glyburide is an effective and well-tolerated drug compared to insulin in the management of women with GDM, provided neonates are monitored for hypoglycemia and Apgar score. In addition, glyburide was associated with lower cesarean sections, which may add to the potential clinically benefits of glyburide compared to insulin.

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Authors and Affiliations

  1. Obstetrics and Gynecology Department, Faculty of Medicine, Zagazig University, Zagazig, 44519, Egypt

    Khaled Fathy Helal, Mohammad Samir Badr, Mohamed El-Sayed Rafeek, Walid Mohamed Elnagar & Mohamed El-Bakry Lashin

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  1. Khaled Fathy Helal
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  2. Mohammad Samir Badr
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Contributions

KFH: formulating the idea, literature search, screening, data extraction, and writing of the manuscript. MSB: literature search, screening, data analysis and writing the results. MSR: data extraction, manuscript writing and revision. WME: data extraction, manuscript writing and revision. MBL: final revision of the manuscript.

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Correspondence to Khaled Fathy Helal.

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Helal, K.F., Badr, M.S., Rafeek, M.ES. et al. Can glyburide be advocated over subcutaneous insulin for perinatal outcomes of women with gestational diabetes? A systematic review and meta-analysis. Arch Gynecol Obstet 301, 19–32 (2020). https://doi.org/10.1007/s00404-019-05430-3

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