Editorials

Which oral hypoglycaemic for gestational diabetes?

BMJ 2015; 350 doi: https://doi.org/10.1136/bmj.h177 (Published 21 January 2015) Cite this as: BMJ 2015;350:h177
  1. David A Sacks, associate investigator; clinical professor12
  1. 1Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
  2. 2Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Southern California, Keck School of Medicine, Los Angeles, California, USA
  1. dasacks1{at}verizon.net

Latest evidence favours metformin over glibenclamide, but there’s more work to do on both agents

Gestational diabetes constitutes over 80% of diabetes seen during pregnancy1 and is increasing in prevalence.2 That gestational diabetes is associated with specific adverse maternal, fetal, and neonatal outcomes has been clearly established.3 The care of the pregnant woman with gestational diabetes has long been based on the assumption of a causal or a co-varying relationship between maternal hyperglycaemia and these adverse outcomes.4 Balsells and colleagues’ meta-analysis (doi:10.1136/bmj.h102) analyzes the consequences of contemporary efforts to minimize the adverse effects of maternal hyperglycaemia.5 Results were somewhat mixed, but, of the two oral agents, metformin had a significantly better risk-benefit profile that glibenclamide (glyburide).

A progressive decrease in insulin sensitivity with advancing gestational age is a normal accompaniment of pregnancy. In contrast with their non-diabetic peers, women destined to develop gestational diabetes have significantly lower insulin sensitivity before conception despite maintaining normal glucose tolerance. During pregnancy, the amount of insulin that women with gestational diabetes release in response to a glucose load is significantly less than that released by pregnant women without gestational diabetes, and a glucose tolerance …

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