Comparative Efficacy and Safety of Metformin, Glyburide, and Insulin in Treating Gestational Diabetes Mellitus: A Meta-Analysis
To compare the efficacy and safety of metformin, glyburide, and insulin in treating gestational diabetes mellitus (GDM), a meta-analysis of randomized controlled trials (RCTs) was conducted. PubMed, Embase, CINAHL, Web of Science, and Cochrane Library to November 13, 2018, were searched for RCT adju...
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| Format: | Article |
| Language: | English |
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Wiley
2019-01-01
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| Series: | Journal of Diabetes Research |
| Online Access: | http://dx.doi.org/10.1155/2019/9804708 |
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| author | Lanlan Guo Jing Ma Jia Tang Dingyao Hu Wei Zhang Xue Zhao |
| author_facet | Lanlan Guo Jing Ma Jia Tang Dingyao Hu Wei Zhang Xue Zhao |
| author_sort | Lanlan Guo |
| collection | DOAJ |
| description | To compare the efficacy and safety of metformin, glyburide, and insulin in treating gestational diabetes mellitus (GDM), a meta-analysis of randomized controlled trials (RCTs) was conducted. PubMed, Embase, CINAHL, Web of Science, and Cochrane Library to November 13, 2018, were searched for RCT adjusted estimates of the efficacy and safety of metformin, glyburide, and insulin treatments in GDM patients. There were 41 studies involving 7703 GDM patients which were included in this meta-analysis; 12 primary outcomes and 24 secondary outcomes were detected and analyzed. Compared with metformin, insulin had a significant increase in the risk of preeclampsia (RR, 0.57; 95% CI, 0.45 to 0.72; P<0.001), NICU admission (RR, 0.75; 95% CI, 0.64 to 0.87; P<0.001), neonatal hypoglycemia (RR, 0.57; 95% CI, 0.49 to 0.66; P<0.001), and macrosomia (RR, 0.68; 95% CI, 0.55 to 0.86; P<0.05). To the outcomes of birth weight and gestational age at delivery, insulin had a significant increase when compared with metformin (MD, 114.48; 95% CI, 37.32 to 191.64; P<0.01; MD, 0.23; 95% CI, 0.12 to 0.34; P<0.001; respectively). Of the two groups between glyburide and metformin, metformin had lower gestational weight gain compared with glyburide (MD, 1.67; 95% CI, 0.26 to 3.07; P<0.05). Glyburide had a higher risk of neonatal hypoglycemia compared with insulin (RR, 1.76; 95% CI, 1.32 to 2.36; P<0.001). This meta-analysis found that metformin could be a safe and effective treatment for GDM. However, clinicians should pay attention on the long-term offspring outcomes of the relative data with GDM patients treated with metformin. Compared with insulin, glyburide had a higher increase of neonatal hypoglycemia. The use of glyburide in pregnancy for GDM women appears to be unclear. |
| format | Article |
| id | doaj-art-e18abf804bcf4c52a461df1bda0980b9 |
| institution | DOAJ |
| issn | 2314-6745 2314-6753 |
| language | English |
| publishDate | 2019-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of Diabetes Research |
| spelling | doaj-art-e18abf804bcf4c52a461df1bda0980b92025-08-20T03:20:58ZengWileyJournal of Diabetes Research2314-67452314-67532019-01-01201910.1155/2019/98047089804708Comparative Efficacy and Safety of Metformin, Glyburide, and Insulin in Treating Gestational Diabetes Mellitus: A Meta-AnalysisLanlan Guo0Jing Ma1Jia Tang2Dingyao Hu3Wei Zhang4Xue Zhao5Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, ChinaDepartment of Endocrinology and Metabolism, Gansu Provincial Hospital, Lanzhou 730000, ChinaDepartment of Infectious Diseases, Huashan Hospital, Fudan University, Shanghai 200041, ChinaThe Second Clinical Medical College, Lanzhou University, Lanzhou 730000, ChinaDepartment of Critical Care Medicine, Affiliated Hospital of Zunyi Medical College, Zunyi 563000, ChinaDepartment of Nephrology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan 250021, ChinaTo compare the efficacy and safety of metformin, glyburide, and insulin in treating gestational diabetes mellitus (GDM), a meta-analysis of randomized controlled trials (RCTs) was conducted. PubMed, Embase, CINAHL, Web of Science, and Cochrane Library to November 13, 2018, were searched for RCT adjusted estimates of the efficacy and safety of metformin, glyburide, and insulin treatments in GDM patients. There were 41 studies involving 7703 GDM patients which were included in this meta-analysis; 12 primary outcomes and 24 secondary outcomes were detected and analyzed. Compared with metformin, insulin had a significant increase in the risk of preeclampsia (RR, 0.57; 95% CI, 0.45 to 0.72; P<0.001), NICU admission (RR, 0.75; 95% CI, 0.64 to 0.87; P<0.001), neonatal hypoglycemia (RR, 0.57; 95% CI, 0.49 to 0.66; P<0.001), and macrosomia (RR, 0.68; 95% CI, 0.55 to 0.86; P<0.05). To the outcomes of birth weight and gestational age at delivery, insulin had a significant increase when compared with metformin (MD, 114.48; 95% CI, 37.32 to 191.64; P<0.01; MD, 0.23; 95% CI, 0.12 to 0.34; P<0.001; respectively). Of the two groups between glyburide and metformin, metformin had lower gestational weight gain compared with glyburide (MD, 1.67; 95% CI, 0.26 to 3.07; P<0.05). Glyburide had a higher risk of neonatal hypoglycemia compared with insulin (RR, 1.76; 95% CI, 1.32 to 2.36; P<0.001). This meta-analysis found that metformin could be a safe and effective treatment for GDM. However, clinicians should pay attention on the long-term offspring outcomes of the relative data with GDM patients treated with metformin. Compared with insulin, glyburide had a higher increase of neonatal hypoglycemia. The use of glyburide in pregnancy for GDM women appears to be unclear.http://dx.doi.org/10.1155/2019/9804708 |
| spellingShingle | Lanlan Guo Jing Ma Jia Tang Dingyao Hu Wei Zhang Xue Zhao Comparative Efficacy and Safety of Metformin, Glyburide, and Insulin in Treating Gestational Diabetes Mellitus: A Meta-Analysis Journal of Diabetes Research |
| title | Comparative Efficacy and Safety of Metformin, Glyburide, and Insulin in Treating Gestational Diabetes Mellitus: A Meta-Analysis |
| title_full | Comparative Efficacy and Safety of Metformin, Glyburide, and Insulin in Treating Gestational Diabetes Mellitus: A Meta-Analysis |
| title_fullStr | Comparative Efficacy and Safety of Metformin, Glyburide, and Insulin in Treating Gestational Diabetes Mellitus: A Meta-Analysis |
| title_full_unstemmed | Comparative Efficacy and Safety of Metformin, Glyburide, and Insulin in Treating Gestational Diabetes Mellitus: A Meta-Analysis |
| title_short | Comparative Efficacy and Safety of Metformin, Glyburide, and Insulin in Treating Gestational Diabetes Mellitus: A Meta-Analysis |
| title_sort | comparative efficacy and safety of metformin glyburide and insulin in treating gestational diabetes mellitus a meta analysis |
| url | http://dx.doi.org/10.1155/2019/9804708 |
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