Glyburide bandwagon is picking up steam: gestational diabetes.(Obstetrics)

SAN FRANCISCO -- The 14 perinatologists at Kaiser Permanente Medical Center in San Francisco seldom agree on anything, but they do agree on glyburide as the drug of choice to treat gestational diabetes, Dr. Robin Field said at a meeting on antepartum and intrapartum management sponsored by the University of California, San Francisco.

Oral hypoglycemics are not recommended during pregnancy by the American College of Obstetricians and Gynecologists. Clinicians at the Kaiser center, however, have used glyburide--an oral, second-generation sulfonylurea--as the primary treatment of gestational diabetes since February 2001 in patients who fail diet therapy.

"I realize this is somewhat of a contrarian view," said Dr. Field director of perinatal services at the center.

A randomized, controlled trial showing glyburide's efficacy in 404 women with gestational diabetes convinced the Kaiser clinicians to change their protocol and offer glyburide instead of insulin (N. Engl. J. Med. 343[16]:1134-38, 2000). In a more recent study by some of the same investigators, glyburide also proved to be effective and convenient in 60 women with gestational diabetes treated in a real-life clinical setting (OB.GYN. NEWS, June 15, 2003, p. 12).

"Glyburide comes in a pill. Insulin requires an injection. Which one would you use?" Dr. Field asked at the meeting.