Medizinische Universität Graz - Research portal
Selected Publication:
Loidl, L.
Glyburide and Metformin in treatment of Gestational Diabetes mellitus
[ Diplomarbeit ] Medical University of Graz; 2013. pp. 65
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- Authors Med Uni Graz:
- Advisor:
- Desoye Gernot
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- Abstract:
- Prevalence of gestational diabetes mellitus is rising globally due to increase of obesity and sedentary life-style. By now, insulin is the gold standard of treatment when diet and exercise alone do not last out for achievement of target blood glucose values. Inadequate glucose control significantly increases the risk of maternal and fetal morbidity and mortality. To many women the injection of the hormone with syringes appears frightening and strain. Clinicians fear that this might cause compliance problems, which lead to reduced implementation of required measures and in turn, poor metabolic control. Until now, the use of oral anti-diabetic agents is recommended in the therapeutic schedule of non-pregnant type 2 diabetics, when diet and exercise alone do not suffice for satisfying treatment. The intake of one or two pills a day instead of up to 5 injections at certain times will be more convenient for pregnant patients and likelier to be understood and accepted. Further, the dose adjustment is simple and the costs are lower for oral anti-hyperglycemic medication compared to insulin. For these reasons oral anti-diabetic agents have been used in treatment of GDM for about 40 years in low-resource countries, although these agents are neither recommended nor approved by international societies like the FDA (United States Food and Drug Administration) or EMA (European Medicines Agency). Metformin and glyburide seem to be the most promising advantages for treatment of GDM. Metformin is a biguanide class agent and has been proven to cross the placenta, but seems to have a positive effect on maternal and fetal weight gain during gestational period. The sulfonylurea derivate glyburide is highly probably not to cross the placenta and has been shown with lower rates of treatment failure compared to metformin. Both medications may be an adequate alternative to insulin in the treatment of GDM without affecting the fetus adversely. Nevertheless, there is still very limited data available on the impact of treatment on the development of offspring after delivery. The demand for treatment of GDM with oral medication is given. This literature review was initiated to update the balance of pros and cons, underpinned by the results of evidence-based research on this topic.