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Word of the Day

Oral hypoglycemics = insulin for management of GDM

Clinical Question:
How do outcomes compare for women with gestational diabetes and their newborns when treated with oral hypoglycemic agents versus insulin?

Bottom Line:
Oral hypoglycemics and insulin produced equivalent results for blood sugar control and patient-oriented outcomes in this meta-analysis of 6 relatively small randomized controlled trials. Oral agents were markedly preferred in the one study that assessed patient satisfaction. Differences in risk for rare adverse effects cannot be excluded. (LOE = 1a-)

Reference:
Dhulkotia JS, Ola B, Fraser R, Farrell T. Oral hypoglycemic agents vs insulin in management of gestational diabetes: a systematic review and meta-analysis. Am J Obstet Gynecol 2010;203(5):457.e1-e9.  [PMID:20739011]

Study Design:
Meta-analysis (randomized controlled trials)

Funding:
Unknown/not stated

Setting:
Various (meta-analysis)

Synopsis:
Inclusion criteria for this meta-analysis of randomized controlled trials included enrollment of women with gestational diabetes (N = 1388), a comparison of insulin with oral hypoglycemic agents (metformin or gliburide), and reported outcomes of interest. There were no significant differences in blood sugar control; neonatal hypoglycemia; birthweight; large-for-gestational age newborns; or other neonatal outcomes, including neonatal intensive care admission, respiratory distress syndrome, birth injuries, preterm birth, neonatal anomalies, or intrauterine fetal death. There were also no significant differences in the incidences of hypoglycemia, maternal hypertensive disorders, or cesarean delivery. Only one study with 733 participants assessed patient satisfaction; it found a marked difference, with 77% satisfied with oral agents (because of ease of administration) and only 27% satisfied with insulin.

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