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Metformin, glyburide combination increases treatment success rate in gestational diabetes
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In women with gestational diabetes, a combination of metformin and glyburide therapy resulted in improved glycemic control for most women when monotherapy with either drug failed, according to findings from a randomized controlled trial in Israel.
Zohar Nachum, MD, of the department of obstetrics and gynecology at Emek Medical Center in Afula, Israel, and colleagues analyzed data from 104 women with gestational diabetes between 13 and 33 weeks’ gestation, recruited between 2012 and June 2014. Researchers randomly assigned patients 850 mg to 2,550 mg per day metformin (n = 51; mean age, 34 years) or 2.5 mg to 20 mg per day glyburide (n = 53; mean age, 33 years), taken 30 minutes before a meal and/or at 10 p.m. If optimal glycemic control was not reached, the other drug was added to the regimen. If adverse effects occurred, the drug was replaced. If both failed, insulin was given. Treatment failure was defined as repeated preprandial glucose values greater than 95 mg/dL, repeated postprandial values greater than 130 mg/dL, an average daily glucose value greater than 100 mg/dL or discontinuation due to medication-related adverse effects. Primary outcomes were the rate of treatment failure and glycemic control after the first-line medication.
In the glyburide group, the drug failed in 18 (34%) patients; hypoglycemia in six patients and lack of glycemic control in 12 patients. In the metformin group, the drug failed in 15 (29%) patients; gastrointestinal adverse events in one patient and lack of glycemic control in 14 patients.
Treatment success after second-line therapy was higher in the metformin vs. the glyburide group (87% vs. 50%; P = .03). In the glyburide group, nine patients were eventually treated with insulin vs. two in the metformin group (P = .03).
The combination of the drugs reduced the need for insulin from 33 (32%) to 11 (11%) patients (P = .0002), according to researchers.
“We hypothesized that because the two medications act with different mechanisms, one would succeed where the other failed to achieve glycemic control and particularly if the medication was discontinued because of adverse effects,” the researchers wrote. “This strategy raised treatment success from 69% to 89%, leading to only 11% of the patients needing insulin.”
Mean daily blood glucose and other obstetric and neonatal outcomes were comparable between groups, the researchers noted, including macrosomia, neonatal hypoglycemia and electrolyte imbalance.
“Glyburide and metformin are comparable oral treatments for [gestational diabetes] regarding glucose control and treatment failure,” the researchers wrote. “Their combination allows a higher efficacy rate with a significant reduced need for insulin that should be reserved for patients who failed to respond to both oral treatments, or who experienced adverse effects as a result of both.” – by Regina Schaffer
Disclosure: The researchers report no relevant financial disclosures.
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