Comparison of glyburide and insulin in the management of gestational diabetes: A meta-analysis

Objective
The aim of this meta-analysis was to determine the efficacy and safety of glyburide as a treatment for gestational diabetes mellitus (GDM) compared to insulin.
Methods
A meta-analysis was conducted to compare the management of gestational diabetes with glyburide and insulin. Studies fulfilling all of the following inclusion criteria were included in this meta-analysis: subjects were women with gestational diabetes requiring drug treatment; the comparison treatment included glyburide vs insulin; one or more outcomes (maternal or neonatal) should be provided in the individual study; the study design should be a randomized control trial. Exclusion criteria: non-RCT studies; non-human data. PubMed, Embase and CENTRAL databases were searched from inception until 10 October 2016.
Results
Ten randomized control trials involving 1194 participants met the inclusion criteria and were included. 13 primary outcomes (6 maternal, 7 neonatal) and 26 secondary outcomes (9 maternal, 17 neonatal) were detected and analyzed in this study. Glyburide significantly increased the risk of any neonatal hypoglycemia [risk ratio (RR), 1.89; 95% confidence interval (95%CI), 1.26 to 2.82; p = 0.002]. Sensitivity analysis confirmed robustness of this result [RR, 2.29; 95%CI, 1.49 to 3.54; p = 0.0002]. No differences were observed between the two groups with respect to birth weights [mean difference (MD), 79; 95%CI, -64 to 221.99; p = 0.28] and the risk of macrosomia [RR, 1.69; 95%CI, 0.57 to 5.08; p = 0.35].
Conclusion
For women with gestational diabetes, no differences in maternal short term outcomes were observed in those treated with glyburide or insulin. However, the incidence of neonatal hypoglycemia was higher in the glyburide group compared to the insulin group.

### 研究目的
本项Meta分析旨在对比格列本脲（glyburide）与胰岛素治疗妊娠糖尿病（gestational diabetes mellitus, GDM）的疗效与安全性。
### 研究方法
本研究通过Meta分析比较格列本脲与胰岛素对妊娠糖尿病的干预效果。纳入满足以下全部纳入标准的研究：研究对象为需药物治疗的妊娠糖尿病女性；对照干预方式为格列本脲对比胰岛素；单项研究需提供一项或多项结局指标（母体或新生儿相关）；研究设计为随机对照试验（randomized control trial, RCT）。排除标准：非随机对照试验研究、非人类研究数据。检索PubMed、Embase及CENTRAL数据库，检索时限为建库至2016年10月10日。
### 研究结果
本研究共纳入10项符合纳入标准的随机对照试验，涉及1194名受试者。本研究共检测并分析了13项主要结局指标（6项母体相关、7项新生儿相关）及26项次要结局指标（9项母体相关、17项新生儿相关）。格列本脲显著升高了任意类型新生儿低血糖的发生风险[相对危险度（risk ratio, RR）=1.89；95%置信区间（95% confidence interval, 95%CI）：1.26~2.82；p=0.002]。敏感性分析证实该结果具有稳健性[RR=2.29；95%CI：1.49~3.54；p=0.0002]。两组在出生体重[均数差（mean difference, MD）=79；95%CI：-64~221.99；p=0.28]及巨大儿发生风险[RR=1.69；95%CI：0.57~5.08；p=0.35]方面无显著差异。
### 研究结论
对于妊娠糖尿病女性，格列本脲与胰岛素治疗的母体短期结局无显著差异。但格列本脲组的新生儿低血糖发生率显著高于胰岛素组。