Glyburide versus metformin in management of gestational diabetes mellitus: a systematic review

Abstract

OBJECTIVE

To identify the efficacy of glyburide and metformin for the management of patients with gestational diabetes mellitus (GDM)

METHODS

We systematically searched through electronic databases including Pubmed, Scopus and The Cochrane Library as well as hand searching of both published and unpublished randomized controlled trials (RCT) and observational studies of acceptable quality to assess the effectiveness of glyburide compared with metformin the in management of gestational diabetes mellitus. The primary outcome was maternal fasting glucose (FBG) level.

RESULTS

We included three RCTs with a total of 421 pregnant women with gestational diabetes mellitus. Most of included trials had a low risk of bias. The meta-analysis showed no difference between glyburide and metformin for controlling maternal FBG (standard mean difference [SMD] 0.10; 95% confidence interval [CI] [-0.46 to 0.66]; I2=87%). Comparing between glyburide group and metformin group, the former had a significant increase in neonatal birth weight (SMD 0.37; 95% CI [0.18 to 0.57]; I2=0%), higher rate of infant with large for gestational age (relative risk [RR] 2.32; 95% CI [1.23 to 4.37]; I2=0%), higher maternal weight gain (SMD 0.32; 95% CI [0.08 to 0.56]; I2=0%) and lower capillary glycemia (mg/dL) at 1 and 3 hour (SMD -0.34; 95% CI [-0.58 to -0.10]; I2=0%; SMD -0.46; 95% CI [-0.70 to -0.22]; I2=0%, respectively).

CONCLUSION

Glyburide comparing with metformin in the management of GDM had no statistical difference in controlling maternal FBG.