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Since the publication in the New England Journal of Medicine (NEJM) in 2000 of the Langer's trial comparing glyburide vs insulin in the treatment of gestational diabetes mellitus (GDM), additional studies of oral agents for the treatment of GDM have been published (observational, randomized controlled trials (RCT), and trials using other drugs like metformin).
Some meta-analysis to summarize the evidence have been published: Nicholson 2009 (including 4 RCT addressing different drugs), Dhulkotia 2010 (including 6 RCT addressing different drugs, the meta-analysis combining all drugs altogether), Gui 2013 (including 5 RCT addressing metformin vs insulin).
Oral agents are increasingly used for the treatment of GDM. Investigators aim to update the evidence on RCTs comparing glyburide and metformin vs insulin or between them and summarize this evidence using meta-analysis tools. Specifically, investigators aim at producing distinct meta-analyses for each one of the three drug comparisons. This information is not available in the literature since the most recent systematic reviews specifically dealing on oral agents for the treatment of GDM have addressed a single drug comparison (Gui 2013) or have combined different drug comparisons into a single meta-analysis (Dhulkotia 2010)
This project involves the systematic review of RCT addressing the use of glyburide or metformin for the treatment of GDM. The review will include RCT comparing these drugs versus insulin or making direct comparisons between the two oral agents in pregnant women with GDM.
Investigators have pre-specified a series of maternal and fetal outcomes of interest.
A comprehensive electronic search strategy will be complemented with a search of bibliographies from relevant studies and the contact of authors from the eligible studies regarding issues on study design or information on primary outcomes.
The risk of bias of included studies will be analyzed and this information used to perform sensitivity analyses. If possible, data from original studies will be pooled into relative risks for dichotomous outcomes and mean differences for continuous outcomes.
Heterogeneity will be explored for all the analyses. Analyses will be undertaken using a fixed effects model that will be repeated using a random effects model in case of substantial heterogeneity.
Results of the systematic review will be published following PRISMA guidance.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Glyburide (Glyburide vs Insulin) | Glyburide vs Insulin trials |
| |
| Insulin (Glyburide vs Insulin) | Glyburide vs Insulin trials |
| |
| Metformin (Metformin vs Insulin) | Metformin vs Insulin trials |
| |
| Insulin (Metformin vs Insulin) | Metformin vs Insulin trials |
| |
| Metformin (Metformin vs Glyburide) | Metformin vs Glyburide trials |
| |
| Glyburide (Metformin vs Glyburide) | Metformin vs Glyburide trials |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Glyburide vs Insulin trials | Drug | Affecting groups 1 and 2 |
|
| Measure | Description | Time Frame |
|---|---|---|
| 3rd trimester glycated hemoglobin | mean difference of 3rd trimester glycated hemoglobin | 3rd trimester of pregnancy |
| total maternal weight gain | mean difference of total maternal weight gain (as defined by the authors) | during pregnancy |
| severe maternal hypoglycemia | relative risk of severe maternal hypoglycemia (as defined by the authors) | from enrollment to delivery |
| preeclampsia | relative risk of preeclampsia (as defined by the authors) | during pregnancy or puerperium |
| cesarean section | relative risk of cesarean section (as defined by the authors) | at the end of pregnancy |
| gestational age at birth | mean difference of gestational age at birth (as defined by the authors) | at birth |
| preterm birth | relative risk of preterm birth (as defined by the authors) | at birth |
| birthweight | mean difference of birthweight (as defined by the authors) | at birth |
| Measure | Description | Time Frame |
|---|---|---|
| fasting blood glucose | mean difference of fasting blood glucose (as defined by the authors) | in the period from enrollment to delivery |
| postprandial blood glucose | mean difference of postprandial blood glucose (as defined by the authors) |
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Inclusion Criteria:
Exclusion Criteria:
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pregnant women with gestational diabetes mellitus requiring drug treatment
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Hospital de la Santa Creu i Sant Pau | Barcelona | Barcelona | 08025 | Spain |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 11036118 | Background | Langer O, Conway DL, Berkus MD, Xenakis EM, Gonzales O. A comparison of glyburide and insulin in women with gestational diabetes mellitus. N Engl J Med. 2000 Oct 19;343(16):1134-8. doi: 10.1056/NEJM200010193431601. | |
| 18463376 | Background | Rowan JA, Hague WM, Gao W, Battin MR, Moore MP; MiG Trial Investigators. Metformin versus insulin for the treatment of gestational diabetes. N Engl J Med. 2008 May 8;358(19):2003-15. doi: 10.1056/NEJMoa0707193. |
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| Metformin vs Insulin trials | Drug | Affecting groups 3 and 4 |
|
| Metformin vs Glyburide trials | Drug | Affecting groups 5 and 6 |
|
| macrosomia | relative risk of macrosomia (defined as birthweight >=4000 g) | at birth |
| large-for-gestational age newborn | relative risk of large-for-gestational age newborn (as defined by the authors) | at birth |
| small-for-gestational age newborn | relative risk of small-for-gestational age newborn (as defined by the authors) | at birth |
| neonatal hypoglycemia | relative risk of neonatal hypoglycemia (as provided by the authors) | in the neonatal period |
| perinatal mortality | relative risk of perinatal mortality (as defined by the authors) | in the perinatal period |
| insulin treatment | relative risk of insulin treatment (for trials comparing metformin vs glyburide) | from enrollment to delivery |
| in the period from enrollment to delivery |
| maternal weight gain since enrollment | mean difference of maternal weight gain since enrollment (as defined by the authors) | in the period from enrollment to delivery |
| pregnancy-induced hypertension | relative risk of pregnancy-induced hypertension (as defined by the authors) | during pregnancy |
| induction of labour | relative risk of induction of labour (as described by the authors) | at the end of pregnancy |
| cord C peptide | mean difference of cord C peptide (as defined by the authors) | at birth |
| cord insulin | mean difference of cord insulin (as defined by the authors) | at birth |
| abnormal 1 min Apgar | relative risk of abnormal 1 min Apgar (defined as lower than 7) | at birth |
| abnormal 5 min Apgar | relative risk of abnormal 5 min Apgar (defined as lower than 7) | at birth |
| obstetric trauma | relative risk of obstetric trauma (as defined by the authors) | at birth |
| severe neonatal hypoglycemia | relative risk of severe neonatal hypoglycemia (as defined by the authors) | in the neonatal period |
| neonatal jaundice | relative risk of neonatal jaundice (as defined by the authors) | in the neonatal period |
| significant respiratory distress | relative risk of significant respiratory distress (described as respiratory distress syndrome or requiring respiratory support) | in the neonatal period |
| stillbirth | relative risk of stillbirth (as defined by the authors) | in the antenatal period |
| neonatal mortality | relative risk of neonatal mortality (as defined by the authors) | in the neonatal period |
| Neonatal Intensive Care Unit (NICU) admittance | relative risk of NICU admittance (as defined by the authors) | in the neonatal period |
| 20739011 | Background | Dhulkotia JS, Ola B, Fraser R, Farrell T. Oral hypoglycemic agents vs insulin in management of gestational diabetes: a systematic review and metaanalysis. Am J Obstet Gynecol. 2010 Nov;203(5):457.e1-9. doi: 10.1016/j.ajog.2010.06.044. Epub 2010 Aug 24. |
| 19104375 | Background | Nicholson W, Bolen S, Witkop CT, Neale D, Wilson L, Bass E. Benefits and risks of oral diabetes agents compared with insulin in women with gestational diabetes: a systematic review. Obstet Gynecol. 2009 Jan;113(1):193-205. doi: 10.1097/AOG.0b013e318190a459. |
| 23724063 | Background | Gui J, Liu Q, Feng L. Metformin vs insulin in the management of gestational diabetes: a meta-analysis. PLoS One. 2013 May 27;8(5):e64585. doi: 10.1371/journal.pone.0064585. Print 2013. |
| 22505499 | Background | Silva JC, Fachin DR, Coral ML, Bertini AM. Perinatal impact of the use of metformin and glyburide for the treatment of gestational diabetes mellitus. J Perinat Med. 2012 Jan 10;40(3):225-8. doi: 10.1515/jpm-2011-0175. |
| 25609400 | Derived | Balsells M, Garcia-Patterson A, Sola I, Roque M, Gich I, Corcoy R. Glibenclamide, metformin, and insulin for the treatment of gestational diabetes: a systematic review and meta-analysis. BMJ. 2015 Jan 21;350:h102. doi: 10.1136/bmj.h102. |
| ID | Term |
|---|---|
| D016640 | Diabetes, Gestational |
| D007333 | Insulin Resistance |
| ID | Term |
|---|---|
| D011248 | Pregnancy Complications |
| D005261 | Female Urogenital Diseases and Pregnancy Complications |
| D000091642 | Urogenital Diseases |
| D003920 | Diabetes Mellitus |
| D044882 | Glucose Metabolism Disorders |
| D008659 | Metabolic Diseases |
| D009750 | Nutritional and Metabolic Diseases |
| D004700 | Endocrine System Diseases |
| D006946 | Hyperinsulinism |
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