Glibenclamide, metformin, and insulin for the treatment of gestational diabetes: a systematic review and meta-analysis.
Glibenclamide, metformin, and insulin for the treatment of gestational diabetes: a systematic review and meta-analysis.
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DOI：
10.1136/bmj.h102
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发表时间：
2015-01-21
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影响因子：
--
通讯作者：
Corcoy R
中科院分区：
文献类型：
--
作者：
Balsells M;García-Patterson A;Solà I;Roqué M;Gich I;Corcoy R
目的 总结随机对照试验中比较格列本脲或二甲双胍与胰岛素或彼此之间在需要药物治疗的妊娠期糖尿病女性中的短期结果。设计系统回顾和荟萃分析。选择研究的资格标准 满足以下所有条件的随机对照试验：（1）以全文发表； (2) 解决需要药物治疗的妊娠糖尿病妇女问题； (3) 比较格列本脲与胰岛素、二甲双胍与胰岛素、或二甲双胍与格列本脲； (4) 提供有关母亲或胎儿结局的信息。数据来源 Medline、CENTRAL 和 Embase 的检索截止日期为 2014 年 5 月 20 日。 结果测量 我们考虑了 14 个主要结局（6 个孕产妇，8 个胎儿）和 16 个次要结局（5 个孕产妇，11 个胎儿）。结果 我们分析了 15 篇文章，包括 2509 名受试者。格列本脲 vs 胰岛素主要结局的显着差异包括出生体重（平均差 109 g（95% 置信区间 35.9 至 181））、巨大儿（风险比 2.62（1.35 至 5.08））和新生儿低血糖（风险比 2.04（1.30 至 3.20））。在二甲双胍v胰岛素中，母亲体重增加（平均差-1.14公斤（-2.22至-0.06））、分娩孕周（平均差-0.16周（-0.30至-0.02））和早产（风险比1.50（1.04至2.16））均达到显着性，并有新生儿低血糖的趋势（风险比0.78） （0.60 至 1.01））。在二甲双胍v格列本脲中，母亲体重增加（平均差-2.06 kg（-3.98至-0.14））、出生体重（平均差-209 g（-314至-104））、巨大儿（风险比0.33（0.13至0.81））和大于胎龄新生儿（风险比0.44（0.21至-104））达到显着性。 0.92））。在二甲双胍 vs 胰岛素中，四项次要结局中二甲双胍更好，而在二甲双胍 vs 格列本脲中，二甲双胍有一项更差。二甲双胍的治疗失败率高于格列本脲。结论 短期来看，在需要药物治疗的妊娠期糖尿病女性中，格列本脲的疗效明显不如胰岛素和二甲双胍，而二甲双胍（需要时加用胰岛素）的效果略优于胰岛素。根据这些结果，如果有胰岛素或二甲双胍可用，则格列本脲不应用于治疗妊娠期糖尿病妇女。系统审评注册NCT01998113
Objective To summarize short term outcomes in randomized controlled trials comparing glibenclamide or metformin versus insulin or versus each other in women with gestational diabetes requiring drug treatment. Design Systematic review and meta-analysis. Eligibility criteria for selecting studies Randomized controlled trials that fulfilled all the following: (1) published as full text; (2) addressed women with gestational diabetes requiring drug treatment; (3) compared glibenclamide v insulin, metformin v insulin, or metformin v glibenclamide; and (4) provided information on maternal or fetal outcomes. Data sources Medline, CENTRAL, and Embase were searched up to 20 May 2014. Outcomes measures We considered 14 primary outcomes (6 maternal, 8 fetal) and 16 secondary (5 maternal, 11 fetal) outcomes. Results We analyzed 15 articles, including 2509 subjects. Significant differences for primary outcomes in glibenclamide v insulin were obtained in birth weight (mean difference 109 g (95% confidence interval 35.9 to 181)), macrosomia (risk ratio 2.62 (1.35 to 5.08)), and neonatal hypoglycaemia (risk ratio 2.04 (1.30 to 3.20)). In metformin v insulin, significance was reached for maternal weight gain (mean difference −1.14 kg (−2.22 to −0.06)), gestational age at delivery (mean difference −0.16 weeks (−0.30 to −0.02)), and preterm birth (risk ratio 1.50 (1.04 to 2.16)), with a trend for neonatal hypoglycaemia (risk ratio 0.78 (0.60 to 1.01)). In metformin v glibenclamide, significance was reached for maternal weight gain (mean difference −2.06 kg (−3.98 to −0.14)), birth weight (mean difference −209 g (−314 to −104)), macrosomia (risk ratio 0.33 (0.13 to 0.81)), and large for gestational age newborn (risk ratio 0.44 (0.21 to 0.92)). Four secondary outcomes were better for metformin in metformin v insulin, and one was worse for metformin in metformin v glibenclamide. Treatment failure was higher with metformin than with glibenclamide. Conclusions At short term, in women with gestational diabetes requiring drug treatment, glibenclamide is clearly inferior to both insulin and metformin, while metformin (plus insulin when required) performs slightly better than insulin. According to these results, glibenclamide should not be used for the treatment of women with gestational diabetes if insulin or metformin is available. Systematic review registration NCT01998113
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