Insulin May Be Better Than Glyburide For Some With Gestational Diabetes Interview with:
Dr. Michele Jonsson Funk, PhD
Research Associate Professor, Dept of Epidemiology
Director, Methods Core, Center for Women’s Health Research
University of North Carolina at Chapel Hill and
Dr. Wendy Camelo Castillo, MD, PhD
Post-doctoral fellow at the University of Maryland

Medical Research: What is the background for this study?

Response: Gestational diabetes is a condition that affects between 8-11% of pregnant women worldwide. In the United States, the prevalence of gestational diabetes has more than doubled since the 1990’s. Most women can control their blood glucose levels with changes in diet and exercise, but approximately 10% need to take medication during pregnancy. Over the last decade, the use of glyburide (a pill) to manage gestational diabetes has increased and it is now used more often than insulin (an injectable).

Medical Research: What are the main findings?

Response: Treatment with glyburide (compared with insulin) was associated with higher risks of admission to the neonatal intensive care unit (NICU) (by 41%), respiratory distress (by 63%), hypoglycemia in the newborn (40% ), birth injury (35% ) and being large for gestational age (43% ).  The risk of NICU admission, large for gestational age and respiratory distress between glyburide and insulin treated women was increased by 3.0%, 1.4% and 1.1% respectively.

Medical Research: What should clinicians and patients take away from your report?

Response: These outcomes seem to be related to poor glucose control during pregnancy rather than to a direct adverse effect of the medication. Therefore, not all women treated with glyburide may be achieving the desired glucose levels during pregnancy.

Medical Research: What recommendations do you have for future research as a result of this study?

Response: Due to the large increase in the prevalence of gestational diabetes and the ease of use and low cost of oral agents, we need more evidence regarding their effectiveness. It would be important to identify which women can be treated effectively with glyburide, considering not only the short term but also the long term effects that these treatments may have on the health of their newborns.

Camelo Castillo W, Boggess K, Stürmer T, Brookhart M, Benjamin DK, Jr, Jonsson Funk M. Association of Adverse Pregnancy Outcomes With Glyburide vs Insulin in Women With Gestational Diabetes. JAMA Pediatr. Published online March 30, 2015. doi:10.1001/jamapediatrics.2015.74. Interview with:Dr. Michele Jonsson Funk, PhD & and Dr. Wendy Camelo Castillo, MD, PhD (2015). Insulin May Be Better Than Glyburide For Some With Gestational Diabetes