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Estudio sugiere mejor control metabólico con gliburida que con metformina en DG.

Un estudio randomizado con 149 pacientes muestra que la necesidad de trasladar a pacientes con Diabetes Gestacional desde terapia oral a insulinoterapia fue mayor con metformina (35%) que con glibenclamida (16%). Esta investigación es parte de los cambios significativos que ha experimentado el tratamiento de esta condición en los últimos años.

January 7, 2010 — The failure rate of metformin was approximately
twice that of glyburide when used in the management of gestational
diabetes mellitus (GDM), according to the results of a randomized trial
reported in the January 2010 issue of Obstetrics & Gynecology.

"The goal of this study was to compare blood glucose levels in
patients taking metformin to blood glucose levels in patients taking
glyburide for management of gestational diabetes," write Lisa E. Moore,
MD, from the University of New Mexico School of Medicine in
Albuquerque, and colleagues. "We hypothesized that metformin and
glyburide would show equivalent efficacy in controlling blood glucose
in a head-to-head comparison."

Women with GDM who did not achieve glycemic control with diet were
randomly assigned to receive monotherapy with metformin (n = 75) or
glyburide (n = 74). The main endpoint of the study was glycemic
control, and secondary endpoints were rate of drug failure and neonatal
and obstetric complications.

Mean fasting and 2-hour postprandial blood glucose levels were not
statistically different between the 2 groups for those patients who
achieved adequate glycemic control. However, insulin treatment was
required for inadequate glycemic control in 26 patients in the
metformin group (34.7%) vs 12 patients in the glyburide group (16.2%; P = .01).

"In this study, the failure rate of metformin was 2.1 times higher
than the failure rate of glyburide when used in the management of
gestational diabetes (95% confidence interval [CI], 1.2–3.9)," the
study authors write.

Limitations of this study include small size and insufficient power to address secondary outcomes.

"This study addressed the use of glyburide and metformin as
single-agent therapies," the study authors conclude. "Future studies
are needed to determine whether there is a benefit in continuing these
agents as adjuvant therapies in patients requiring insulin. In
addition, the role of oral agents in patients with pregestational
diabetes either as single agents or in combination with insulin needs
to be addressed in future studies."

The study authors have disclosed no relevant financial relationships.

Obstet Gynecol. 2010;115:55-59. Abstract

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