A recent study published in the Journal of the American Medical Association suggests that while oral glucose-lowering agents such as metformin and glyburide can effectively manage gestational diabetes, they do not meet the noninferiority criteria compared to insulin in preventing infants born large for gestational age (LGA).
The research, led by Dr. Doortje Rademaker of Amsterdam University Medical Center, aimed to evaluate whether an oral medication strategy could match the effectiveness of insulin in reducing the incidence of LGA infants. The study involved 820 pregnant women with gestational diabetes and singleton pregnancies, who were between 16 and 34 weeks of gestation and had not achieved adequate blood sugar control after two weeks of dietary adjustments.
Participants were randomly assigned to either a metformin regimen or insulin treatment (409 and 411 participants, respectively). For the metformin group, glyburide was added if necessary to meet glucose targets, with insulin substituted for glyburide if further adjustments were required.
The study found that 79% of the women in the oral medication group were able to manage their blood glucose without needing insulin. However, when comparing the outcomes for infants born large for gestational age, 23.9% of those in the oral treatment group and 19.9% in the insulin group were classified as LGA. The absolute risk difference was 4.0%, with the confidence interval extending beyond the predefined noninferiority margin of 8%, making it clear that metformin and glyburide did not demonstrate equivalent efficacy to insulin.
In their conclusion, the authors acknowledged that while metformin and glyburide may offer valuable alternatives for managing gestational diabetes, their use does not entirely match insulin’s ability to prevent LGA outcomes. These findings add to the growing body of evidence on the potential role of oral medications in managing gestational diabetes, but also highlight the continued importance of insulin for optimal glycemic control in pregnancy.
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