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Oral agents, insulin can achieve glycemic control in pregnancy
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NEW ORLEANS — Whether patients develop gestational diabetes or enter pregnancy with pre-existing type 1 or type 2 diabetes, available medications can help expectant mothers control their blood glucose levels without causing harm to the pregnancies, according to presenters here.
Although the 2015 American Diabetes Association standard of medical care in diabetes recommends the use of insulin in pregnancy, there are other suitable options that may be preferred by individual patients.
“For some patients, oral antihyperglycemic agents will work well to control glucose, while other patients may require insulin alone or in combination with oral therapy,” Sara Reece, Pharm D, CDE, BC-ADM, of the Philadelphia College of Osteopathic Medicine Georgia Campus School of Pharmacy, told Endocrine Today.
Sara Reece
According to Reece, pregnancy calls for tighter glucose control than patients with pre-existing diabetes might be used to — below 60 mg/dL rather than below 70 mg/dL — and diabetes educators should be certain patients are aware of their modified targets.
Reece and Jennifer Elliott, PharmD, CDE, also of the Philadelphia College of Osteopathic Medicine Georgia Campus School of Pharmacy, reviewed the literature for use of human insulin, insulin analogues, metformin and glyburide in pregnancy, each of which can be an appropriate therapeutic choice to consider, they said.
Jennifer Elliott
“You still get good glycemic control with the rapid-acting analogues as compared to human insulin without additional adverse effects. You typically see less postprandial hypoglycemia,” Reece said.
“There’s plenty of evidence that metformin is safe and effective in [patients with gestational diabetes],” Elliott added.
Most studies comparing glyburide with insulin have shown no statistically significant increased maternal or fetal risks with the oral medication. However, a study by Camelo Castillo and colleagues recently published in JAMA Pediatrics found that mothers treated with glyburide were more likely to experience adverse outcomes than those on insulin.
“[Glyburide] is still used a lot in practice, it still has a lot more data supporting it than this one trial against it, so I’m interested to see the new trials coming out and talking about the safety of it,” Elliott said.
“The big takeaway ... is that the trials have shown it’s not a big red X automatically for metformin and glyburide when you think in terms of pregnancy. They do still possibly still have a role, but insulin is our gold standard,” said Elliott. – by Jill Rollet
Reference:
Camelo Castillo, W, et al. JAMA Pediatr. 2015;doi: 10.1001/jamapediatrics.2015.74.
Elliott J, Reece S. T18. Presented at: The American Association of Diabetes Educators Annual Meeting; Aug. 5-8, 2015; New Orleans.
Disclosure: Elliott and Reece report no relevant financial relationships.