Glyburide efficacy demonstrated in real-life clinical settings. (High Fasting Glucose BMI Predict Failure).

LITTLE ROCK, ARK. - Glyburide is an effective and convenient treatment for gestational diabetes mellitus in real-life clinical practice, Dr. Deborah L. Conway said at the annual meeting of the North American Diabetes in Pregnancy Study Group.

Dr. Conway of the University of Texas, San Antonio, was part of the team that published a landmark study 3 years ago demonstrating the efficacy of glyburide in 404 women with gestational diabetes mellitus (GDM) (N. Engl. J. Med. 343[16]:1134-38, 2000).

Now the investigators have looked to see how glyburide fared in a real-life clinical setting in 60 women with GDM diagnosed at 11-33 weeks' gestation. Unlike the original study group, these women were placed on a low-carbohydrate diet and given a trial with diet alone, regardless of their fasting glucose levels. In the original study, women with a fasting blood glucose level of 95 mg/ dL or greater were automatically randomized to glyburide or insulin.

The glyburide dosing also was modified slightly so that an evening dose could be added if morning fasting glucose levels were high. In the original study the morning dose was simply increased. In the current trial, 75% of the women were able to achieve target glucose values with a total dosage of either 2.5 mg or 5.0 mg/day, Dr. Conway said.

The rate of conversion to insulin was 15%, compared with just 4% in the original trial. Macrosomia occurred in the infants of 12% of the women, compared with just 7% previously. The differences may be due to the fact that in the current study the decision to switch the patients to insulin was made independently by their physicians, rather than by strict clinical protocol. In many cases, the women were not at maximal glyburide doses when they were switched, so they can't really be considered true "failures," she pointed out.

Also, since the implementation of a low-carbohydrate diet in ...