Oral Antidiabetic Agents in Gestational Diabetes Mellitus- Shifting of Paradigm?

Diabetes mellitus is one of the most common medical complications of pregnancy; gestational diabetes mellitus (GDM) accounts for approximately 90-95% of all cases. The incidence of gestational diabetes is increasing. It has been demonstrated that good metabolic control maintained throughout pregnancy can reduce maternal and fetal complications in diabetes Traditionally, insulin therapy has been considered the gold standard for management There has been a traditional reluctance to recommend oral antidiabetic drugs for the management of hyperglycaemia in gestational diabetes mellitus. The medical management of gestational diabetes is still evolving, and recent randomized controlled trials have given a glimse of hope for woman who likes to avoid insulin and prefer oral agents. The current short acting insulin analogs lispro and aspart are safe, but there are only limited data to support the use of long acting insulin analogs. There are randomized controlled trials which have demonstrated efficacy of the oral agents glyburide and metformin. Whilst shortterm data have not demonstrated adverse effects of glyburide and metformin on the fetus, and they are increasingly being used in pregnancy, there remain long-term concerns regarding their potential for harm. This controversy related article gives an overview of the rationale for use of oral antidiabetic agents in the treatment of gestational diabetes. DOI: 10.3329/jdmc.v17i2.6596J Dhaka Med Coll. 2008; 17(2) : 127-130

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Oral Antidiabetic Agents in Pregnancy and Lactation: A Paradigm Shift?

Annals of Pharmacotherapy ◽

10.1345/aph.1k045 ◽

2007 ◽

Vol 41 (7-8) ◽

pp. 1174-1180 ◽

Cited By ~ 39

Author(s):

Denice S Feig ◽

Gerald G Briggs ◽

Gideon Koren

Keyword(s):

Clinical Trial ◽

Randomized Controlled Trial ◽

Gestational Diabetes ◽

Developmental Toxicity ◽

Controlled Trial ◽

Oral Antidiabetic Agents ◽

Antidiabetic Agents ◽

Randomized Controlled ◽

Oral Antidiabetic ◽

In Pregnancy

Objective: To provide information on the use of oral antidiabetic agents in pregnancy and breast-feeding. Data Sources: Primary articles were identified by a MEDLINE search (1966–March 2007) using the MeSH headings: pregnancy in diabetics, pregnancy, polycystic ovary syndrome, hypoglycemic agents, glipizide, glyburide, metformin, rosiglitazone, pioglitazone, clinical trial, controlled clinical trial, multicenter study, randomized controlled trial, case–control studies, and cohort studies. Study Selection and Data Extraction: All studies using oral antidiabetic agents in pregnancy were evaluated and relevant data were included in the discussion. Data Synthesis: Studies of glyburide and glipizide have found little or no transfer of these drugs across the placenta, whereas metformin and rosiglitazone cross readily. Animal studies have found no evidence to suggest that glyburide, glipizide, metformin, or rosiglitazone are teratogenic. In gestational diabetes, glyburide was safe and efficacious; however, 16–19% of women failed to achieve optimal glucose control. No developmental toxicity in infants was observed when metformin was used before and throughout pregnancy in women with polycystic ovarian syndrome (PCOS). Some of the studies involving patients with type 2 diabetes had methodological problems. A randomized controlled trial using metformin for gestational diabetes in the third trimester is underway. The human information is inadequate to evaluate the risk of glipizide or the thiazolidinediones in pregnancy. In breast milk, 3 studies measured nonsignificant amounts of metformin and one study was unable to detect either glyburide or glipizide. Conclusions: Neither glyburide nor metformin has caused developmental toxicity in humans. Glyburide has been used for the treatment of gestational diabetes, and metformin has been used in women with PCOS who eventually became pregnant. Additional trials are needed to better define the benefits and risks of oral antidiabetic agents in pregnancy. Metformin, glyburide, and glipizide appear to be compatible with breast-feeding.

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Oral Antidiabetic Agents: A Comparative Review

Journal of Pharmacy Practice ◽

10.1177/0897190003261307 ◽

2004 ◽

Vol 17 (1) ◽

pp. 39-48 ◽

Cited By ~ 9

Author(s):

Renee R. Koski

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

The United States ◽

Oral Antidiabetic Agents ◽

Antidiabetic Agents ◽

Oral Antidiabetic ◽

Oral Agents ◽

Comparative Review

Type 2 diabetes mellitus is a chronic disease characterized by insulin resistance, impaired insulin secretion, and/or increased hepatic glucose production. The mainstays of drug treatment are the oral antidiabetic agents. Insulin is usually reserved for patients who do not achieve fasting plasma glucose or A1C goals with or cannot tolerate the oral antidiabetic agents. There are 5 classes of oral antidiabetic agents available in the United States: sulfonylureas, biguanides, alpha-glucosidase inhibitors, thiazolidinediones, and nonsulfonylurea secretagogues. They have differences and similarities with respect to their pharmacology and role in diabetes. This article reviews the pharmacology, efficacy, safety, and selection of the oral agents used to treat type 2 diabetes mellitus.

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Metformin in the treatment of gestational diabetes mellitus: is it safe and efficient?

Hellenic Journal of Obstetrics and Gynecology ◽

10.33574/hjog.1688 ◽

2019 ◽

Vol 18 (1) ◽

Author(s):

Argirios Rountis ◽

Kalliopi Pappa

Keyword(s):

Diabetes Mellitus ◽

Gestational Diabetes ◽

Gestational Diabetes Mellitus ◽

Adverse Outcomes ◽

Oral Antidiabetic Agents ◽

Glucose Levels ◽

Blood Glucose Levels ◽

Oral Antidiabetic ◽

Indigenous Production ◽

Maternal Glucose

Gestational diabetes mellitus (GDM) typically occurs when maternal glucose metabolism fails to compensate for the gradually increasing insulin resistance which mainly derives from the indigenous production of diabetogenic placental hormones during pregnancy. With its rising prevalence nowadays, GDM constitutes one of the most serious health problems in pregnant women that may result in both maternal and neonatal adverse outcomes if not treated properly. Although most women succeed in controlling their blood glucose levels with diet alone, some require pharmacological treatment in order to achieve adequate glycemic control. For these women, insulin is considered to be the best pharmacological choice for their treatment. However, a growing number of recent studies suggest oral antidiabetic agents to be equivalent if not superior to insulin in terms of safety and efficacy for the treatment of GDM. The objective of this review is to evaluate efficacy and safety of metformin in the treatment of GDM based on the most recent data of the literature.

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