Risk factors for glyburide failure identified: small open-label trial.(Obstetrics)

BOCA RATON, FLA. -- Almost 80% of patients with gestational diabetes achieved blood sugar control in a small open-label trial of glyburide, Dr. Adiam Haileleul reported at the annual meeting of the South Atlantic Association of Obstetricians and Gynecologists.

Women who failed to obtain control had higher prepregnancy weights and higher weight at delivery, higher baseline glucose levels, and lower levels of education than women who achieved control, reported Dr. Haileleul, a resident at Carolinas Medical Center, Charlotte, N.C.

Glyburide has gained popularity as a pharmacologic treatment for women with gestational diabetes who fail a trial of diet and exercise.

Unlike earlier oral hypoglycemic agents, glyburide does not cross the placenta and is not associated with fetal hypoglycemia. A 2000 study of glyburide versus insulin in gestational diabetes demonstrated that 96% of patients could achieve control on glyburide. However, Dr. Haileleul noted, clinical experience with the drug at Carolinas Medical Center did not yield the same high level of response. "We were having to switch more patients to insulin than we had anticipated, based on the results of that study."

Her open-label trial of glyburide was designed to identify patient characteristics associated with adequate metabolic control using glyburide and to document any maternal or fetal complications associated with the therapy.

The trial included 56 women with singleton pregnancies who developed gestational diabetes. All patients had failed a trial of diet and exercise of at least 1 week and were candidates for pharmacologic therapy.

Of the group, 20% were black, 30% were white, 39% were Hispanic, and 11% were of other races or ethnicities. Education levels varied; 51% had not completed high school. The women ...