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Insulin vs Glyburide for Gestational Diabetes

Insulin vs Glyburide for Gestational Diabetes Opinion EDITORIAL Donald R. Coustan, MD; Linda Barbour, MD, MSPH In 2017, gestational diabetes occurred in approximately 14% then one treatment is not inferior to the other. In this case, of pregnancies throughout the world, ranging from 9% in Africa the investigators specified that an outcome difference in to 12.6% in North America to 21% in Southeast Asia. Al- which the upper confidence limit was less than 7% would indicate that glyburide treatment was not inferior to insulin. though there is not yet global agreement regarding diagnos- The investigators assumed that a composite outcome (mac- Related article page 1773 tic criteria for gestational dia- rosomia [defined as >4000 g or >90th percentile], neonatal betes, there is agreement on the complications of this disor- hypoglycemia [blood glucose <36 mg/dL {<2 mmol/L}], der, including an increased risk of cesarean delivery and and/or hyperbilirubinemia) would occur in 18% of infants preeclampsia in mothers, macrosomia with possible birth in- born to women with gestational diabetes treated with insu- jury and neonatal hypoglycemia and jaundice in infants, child- lin. In 809 women included in the per-protocol analysis, the hood obesity, and type 2 diabetes in both mothers and composite outcome occurred in 23.4% of http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png JAMA American Medical Association

Insulin vs Glyburide for Gestational Diabetes

JAMA , Volume 319 (17) – May 1, 2018

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Publisher
American Medical Association
Copyright
Copyright 2018 American Medical Association. All Rights Reserved.
ISSN
0098-7484
eISSN
1538-3598
DOI
10.1001/jama.2018.4561
pmid
29715338
Publisher site
See Article on Publisher Site

Abstract

Opinion EDITORIAL Donald R. Coustan, MD; Linda Barbour, MD, MSPH In 2017, gestational diabetes occurred in approximately 14% then one treatment is not inferior to the other. In this case, of pregnancies throughout the world, ranging from 9% in Africa the investigators specified that an outcome difference in to 12.6% in North America to 21% in Southeast Asia. Al- which the upper confidence limit was less than 7% would indicate that glyburide treatment was not inferior to insulin. though there is not yet global agreement regarding diagnos- The investigators assumed that a composite outcome (mac- Related article page 1773 tic criteria for gestational dia- rosomia [defined as >4000 g or >90th percentile], neonatal betes, there is agreement on the complications of this disor- hypoglycemia [blood glucose <36 mg/dL {<2 mmol/L}], der, including an increased risk of cesarean delivery and and/or hyperbilirubinemia) would occur in 18% of infants preeclampsia in mothers, macrosomia with possible birth in- born to women with gestational diabetes treated with insu- jury and neonatal hypoglycemia and jaundice in infants, child- lin. In 809 women included in the per-protocol analysis, the hood obesity, and type 2 diabetes in both mothers and composite outcome occurred in 23.4% of

Journal

JAMAAmerican Medical Association

Published: May 1, 2018

References