New research suggests that glibenclamide may be a safe alternative to insulin
for the treatment of gestational diabetes.
Dr Oded Langer (department of obstetrics and gynaecology, St Luke’s-Roosevelt
hospital centre, New York, US) and colleagues compared the effect of glibenclamide
with insulin in achieving glycaemic control in 404 women with gestational diabetes.
They also assessed maternal and neonatal complications.
They found that glibenclamide was as effective as insulin in producing glycaemic
control, although a small number of women (4 per cent) taking glibenclamide
had to be switched to insulin. In addition, they found no differences between
the two groups in perinatal outcome.
Current recommendations state that sulphonylureas should be avoided in pregnancy
because of their potential to cause neonatal hypoglycaemia and foetal anomalies.
However, Dr LAnger et al say that these recommendations were based on studies
of older sulphonylureas. In a previous laboratory study, they demonstrated that
glibenclamide did not cross the human placenta in appreciable quantities in
contrast with older sulphonylureas. This finding was supported in this study,
as glibenclamide was not detected in the cord serum of any infant (New England
Journal of Medicine 2000;343:1134).
In an accompanying editorial, Dr Michael Greene (Massachusetts general hospital,
Boston) comments that concern about the transplacental effects of other sulphonylureas
remains. However, he adds that data about the teratogenicity of oral hypoglycaemic
drugs are limited and do not allow firm conclusions to be drawn about their
safety (Ibid, p1178).
Glibenclamide is not licensed for use in gestational diabetes in the UK.