RESUMO
OBJECTIVE: To evaluate the perinatal impact of metformin and glyburide in the treatment of gestational diabetes mellitus (GDM). METHODS: A randomized clinical trial conducted from July 2008 until September 2010 studied 200 pregnant women with GDM who required adjunctive therapy to diet and physical activity. Patients were randomized to use metformin (n=104) or glyburide (n=96). The drugs were replaced by insulin when they reached the maximum dose without glycemic control. Assessed outcomes: weight and neonatal blood glucose. RESULTS: No difference was found (P>0.05) between the groups regarding maternal age, gestational age at inclusion, body mass index, glucose levels in oral glucose tolerance test (OGTT) 75 g and glycemic control. Difference was found in the number of previous pregnancies (2.84 vs. 2.47, P=0.04) and weight gain during pregnancy (7.78 vs. 9.84, P=0.04) in the metformin group and glyburide respectively. The perinatal results showed no difference (P>0.05) in the percentage of cesarean deliveries, gestational age at delivery, number of newborns large for gestational age (LGA), neonatal hypoglycemia, admission to intensive care unit and perinatal death. We found differences in weight (3193 g vs. 3387 g, P=0.01) and ponderal index (2.87 vs. 2.96, P=0.05) of newborns, and in neonatal blood glucose levels at the 1st (59.78 vs. 54.08, P=0.01) and 3rd h (61.53 vs. 55.89, P=0.01) after birth between the metformin and glyburide groups respectively. CONCLUSIONS: Weight and ponderal index were lower in the newborns of the metformin group; glucose levels (1st and 3rd h after birth) were lower in the glyburide group.
Assuntos
Diabetes Gestacional/tratamento farmacológico , Glibureto/uso terapêutico , Hipoglicemiantes/uso terapêutico , Metformina/uso terapêutico , Adulto , Peso ao Nascer/efeitos dos fármacos , Glicemia/metabolismo , Diabetes Gestacional/patologia , Feminino , Teste de Tolerância a Glucose , Glibureto/efeitos adversos , Humanos , Hipoglicemiantes/administração & dosagem , Hipoglicemiantes/efeitos adversos , Recém-Nascido , Masculino , Metformina/efeitos adversos , Gravidez , Resultado da Gravidez , Aumento de Peso/efeitos dos fármacosRESUMO
OBJETIVOS: avaliar os melhores artigos publicados naliteratura médica acerca do tratamento do diabete mélitogestacional (DMG), verificando a eficácia das drogassobre o controle glicêmico e sua segurança quanto aosresultados perinatais. MÉTODOS: foi realizada busca noportal ?Pubmed? com a seguinte estratégia de busca:?Diabetes, gestational?, utilizando o limite quanto à presençados termos no título ou no resumo. No portal daBireme foi avaliada a literatura nacional e latino-americana,utilizando-se como descritor o termo ?Diabete gestacional?.Também foram incluídos 20 artigos não selecionadosnas bases de dados e constantes em referênciasbibliográficas e artigos clássicos de livros-texto. As referênciassão do período de 1979 até 2011. A revisão deuprioridade a estudos de ensaios clínicos randomizadose relacionados diretamente com o tema. RESULTADOS:a contra-indicação do uso dos hipoglicemiantes orais nagestação é baseada em estudos não controlados e compequena casuística, que mostram um efeito negativo sobrea morbimortalidade materno-fetal. Atualmente estãodisponíveis inúmeros estudos controlados, randomizadoscom grande número de pares avaliados, com eficácia dasdrogas sobre o controle glicêmico oscilando entre 53%e 96% e com resultados perinatais semelhantes entreinsulina, glibenclamida e metformina. CONCLUSÕES: oshipoglicemiantes orais retornam como excelente alternativaà insulinoterapia no tratamento do diabete mélitogestacional após avaliações randomizadas e controladasem número adequado de sujeitos.
PURPOSE: To evaluate the best articles published inmedical literature about the treatment of gestationaldiabetes mellitus (GDM), verifying the effectiveness ofdrugs on glycemic control and its safety regarding theperinatal outcomes. METHODS: We searched the portal?Pubmed? with the following search strategy: ?Diabetes,gestational?, the limit was the presence of thewords in the title or abstract. At the Bireme portal, wereviewed the national literature and latin American literature,using the descriptor ?Diabete gestacional?. Wealso included 20 articles that were not selected in thedatabases but were present at references and articlesof classic textbooks.The references are from the periodof 1979 to 2011.The review has given priority to clinicaltrials studies with direct relation to the subject.RESULTS:a contraindication to the use of oral hypoglycemicagents is based on uncontrolled studies and smallsample size, which show a negative effect on maternaland fetal morbidity and mortality. Currently there aremany randomized controlled trials with large numbersof pairs reviewed, with drug efficacy on glucose controlranging between 53% and 96% and similar perinataloutcomes with insulin, glibenclamide and metformin.CONCLUSIONS: oral hypoglycemic return as an excellentalternative to insulin therapy in the treatment of GDMafter randomized and controlled trial sin adequate numbersof subjects.