Oral glibenclamide as good as insulin for treatment of gestational diabetes mellitus

Azam Faraj, IranShiraz University of Medical Sciences, Iran, and colleagues showed oral glibenclamide to be as safe and effective as subcutaneous insulin in maternal and neonatal outcomes and glycemic control in women with gestational diabetes. Thus, the research team suggests that it could be used as a first-line treatment of GDM.

In the study, the research team aimed to compare the safety and efficacy of oral glibenclamide and subcutaneous insulin on the serum glucose control and perinatal outcome of women with gestational diabetes mellitus in a randomized clinical trial.

The trial was conducted for 2 years from 2017 to 2019 in two tertiary healthcare centres in Shiraz, Iran. The researchers included 84 singleton pregnancies between 24 and 34 weeks of gestation diagnosed with gestational diabetes mellitus. They were randomly assigned to subcutaneous insulin (n = 40) or oral glibenclamide (n = 44) according to a standard protocol and followed until delivery.

The study's primary endpoint was to compare patients' glycemic levels. Secondary outcomes included neonatal complications and pregnancy adverse events, such as neonatal intensive care unit admission, respiratory distress syndrome, hyperbilirubinemia, neonatal hypoglycemia, birth weight, maternal hypoglycemia, placental abruption, preterm labour, preterm and premature rupture of membranes, and preeclampsia.

The study led to the following findings:

• The two study groups had comparable baseline characteristics. After treatment, the two study groups were comparable regarding fasting blood glucose and 2 h postprandial glucose.
• There was no significant difference between the two groups regarding the rate of preeclampsia, preterm rupture of membranes, preterm labour, hypoglycemia, and abruption.
• There was no significant difference between the two study groups in birth weight and the Apgar score at 1 and 5 min.
• The rates of neonatal adverse events, including hypoglycemia, hyperbilirubinemia, neonatal intensive care unit admission, and respiratory distress syndrome, were comparable between the two groups.

"The study's results show that oral glibenclamide is as safe and effective as subcutaneous insulin in glycemic control and maternal and neonatal outcomes in women with gestational diabetes mellitus," the researchers wrote. "Thus, it could be used as a first-line treatment of gestational diabetes mellitus."

Reference:

Faraji A, Tahamtani L, Maharlouei N, Asadi N. Effects of oral glibenclamide versus subcutaneous insulin on perinatal outcome of patients with gestational diabetes mellitus: A randomized clinical trial. Obstet Med. 2023 Jun;16(2):98-103. doi: 10.1177/1753495X221100167. Epub 2022 May 25. PMID: 37441660; PMCID: PMC10334033.