GDM: Pharmacologic Therapy (2008)
What is the evidence regarding pharmacological therapy in women with gestational diabetes mellitus?
Twenty-four studies were evaluated to investigate the use of pharmacological therapy for women with gestational diabetes mellitus (GDM). In conjunction with nutrition therapy, pharmacological therapy is indicated in women with gestational diabetes mellitus when optimal blood glucose levels have not been maintained and/or when the rate of fetal growth is excessive.
Insulin therapy has been shown to be safe and effective in maintaining optimal blood glucose levels and reducing incidence of macrosomia, fetal morbidity and mortality. Five studies regarding the use of insulin analogs reported that lispro or aspart as rapid acting insulins may improve glycemic control and reduce the incidence of macrosomia in neonates. Research on glargine is limited.
Eight studies reported that glyburide therapy is effective in maintaining glycemic control in conjunction with nutrition therapy, especially in women with less severe disease. Research on metformin is limited. Further research on other antidiabetes agents in women with gestational diabetes mellitus is needed.
- Grade I means there is Good/Strong evidence supporting the statement;
- Grade II is Fair;
- Grade III is Limited/Weak;
- Grade IV is Expert Opinion Only;
- Grade V is Not Assignable.
Evidence Summary: What is the evidence to support pharmacological therapy in women with gestational diabetes mellitus?
- Quality Rating Summary
For a summary of the Quality Rating results, click here.
- American Diabetes Association. Gestational diabetes mellitus. Diabetes Care 2002:25(1); S94-S96.
- Bertini AM, Silva JC, Taborda W, Becker F, Bebber FRL, Viesi JMZ, Aquim G, Ribeiro TE. Perinatal outcomes and the use of oral hypoglycemic agents. J Perinat Med 2005;33:519-523.
- Bhattacharyya A, Brown S, Hughes S, Vice PA. Insulin lispro and regular insulin in pregnancy. QJ Med 2001;94:255-260.
- Bonomo M, Cetin I, Pisoni MP, Faden D, Mion E, Taricco E, Nobile de Santis M, Radaelli T, Motta G, Costa M, Solerte L, Morabito A. Flexible treatment of Gestational Diabetes modulated on ultrasound evaluation of intrauterine growth: a controlled randomized clinical trial. Diabetes Metab 2004, 30,237-43.
- Charles B, Norris R, Xiao X, Hague W. Population Pharmacokinetics of Metformin in Late Pregnancy. Ther Drug Monit 2006;28:67-72.
- Chmait R, Dinise T, Moore T. Prospective Observational study to establish predictors of glyburide success in women with gestational diabetes mellitus. Journal of Perinatology 2004;24:617-622.
- Conway DL, Gonzales O, Skiver D. Use of glyburide for the treatment of gestational diabetes: the San Antonio experience. J Matern Fetal Neonatal Med 2004 Jan;15(1):51-5.
- Franz MJ, Horton ES, Bantle JP, Beebe CA, Brunzell JD, Coulston AM, Henry RR, Hoogwerf BJ, Stacpoole PW. Nutrition principles for the management of diabetes and related complications. Diabetes Care 1994; 17:490-518.
- Hellmuth E, Damm P, Molsted-Pedersen L. Oral hypoglycaemic agents in 118 diabetic pregnancies. Diabetic Medicine 2000;17:507-511.
- Jacobson GF, Ramos GA, Ching JY, Kirby RS, Ferrara A, Field DR. Comparison of glyburide and insulin for the management of gestational diabetes in a large managed care organization. American Journal of Obstetrics and Gynecology 2005:193:118-24.
- Kjos S, Schaefer-Graf U, Sardesi S, Peters R, Buley A, Xiang A, Byrne J, Sutherland C, Montoro M, Buchanan T. A randomized controlled trial using glycemic plus fetal ultrasound parameters versus glycemic parameters to determine insulin therapy in gestational diabetes with fasting hyperglycemia. Diabetes Care 2001;24:1904-1910.
- Kremer C, Duff P. Glyburide for the treatment of gestational diabetes. Am J Obstet Gynecol 2004;190(5):1438-9.
- Langer O, Conway DL, Berkus MD, Xenakis EMJ, Gonzalez O. A comparision of glyburide and insulin in women with gestational diabetes mellitus. New Engl J Med 2000;343:1134-8.
- Langer O, Yogev Y, Xenakis EMJ, Rosenn B. Insulin and glyburide therapy: Dosage, severity level of gestational diabetes, and pregnancy outcome. Am J of Obstet Gynec 2005;192:134-9.
- Leipold H, Worda C, Gruber CJ, Kautzky-Willer A, Husslein PW, Bancher-Todesca D. Large-for-gestational-age newborns in women with insulin-treated gestational diabetes under strict metabolic control. Wien Klin Wochenschr 2005;117/15-16:521-525.
- Pettitt DJ, Ospina P, Kolaczynski JW, Jovanovic L. Comparison of an insulin analog, insulin aspart and regular human insulin with no insulin in gestational diabetes mellitus. Diabetes Care 2003;26:183-186.
- Poyhonen-Alho M, Teramo K, Kaaja R. Treatment of gestational diabetes with short-or long-acting insulin and neonatal outcome: a pilot study. Acta Obstet Gynecol Scand 2002;81:258-259.
- Price N, Bartlett C, Gillmer MD. Use of insulin glargine during pregnancy: a case-control pilot study. BJOG 2007;114(4):453-7.
- Rossi G, Somigliana E, Moschetta M, Bottani B, Barbieri M, Vignali M. Adequate timing of fetal ultrasound to quide metabolic therapy in mild gestational diabetes melliutus. Acta Obstet Gynecol Scand 2000;79:649-654.
- Schaefer-Graf UM, Kjos SL, Fauzan OH, Buhling KJ, Siebert G, Buhrer C, Ladendorf B, Dudenhausen JW, Vetter K. A randomized trial evaluating a predominately fetal growth-based strategy to guide management of gestational diabetes in Caucasian women. Diabetes Care 2004; 27(2):297-302.
- Simmons D, Thompson CF, Conroy C, Scott DJ. Use of insulin pumps in pregnancies complicated by Type 2 diabetes and gestational diabetes in a multiethnic community. Diabetes Care 2001;24(12):2078-2082.
- Simpson RW, Kast SJ. Management of gestational diabetes with a conservative insulin protocol. Med J Aust 2000;172:537-540.
- Svare JA, Hansen BB, Molsted-Pedersen L. Perinatal complications in women with gestational diabetes mellitus. Acta Obstet Gynecol Scand 2001;80(10):899-904.
- Yogev Y, Ben-Haroush A, Chen R, Rosenn B, Hod M, Langer O. Undiagnosed asymptomatic hypoglycemia: diet, insulin and glyburide for gestational diabetic pregnancy. Obstet Gynecol 2004;104:88-93.
Search Plan and Results: Pharmacologic Therapy 2006