1124: Glyburide is the least effective gestational diabetes therapy to improve neonatal outcomes. A network Meta-analysis

Metformin and glyburide therapy of gestational diabetes mellitus (GDM) continues to increase. Our objective was to compare pre-selected neonatal outcomes in women with GDM treated with insulin, metformin, glyburide or any combination of these. This is systematic review and network meta-analysis of randomized controlled trials (RCTs) published until May 2019 of women treated for GDM comparing: 1) insulin versus a single oral agent, 2) single oral agent versus another single oral agent, or 3) any combination of these medical therapies. Pre-specified neonatal outcomes were large for gestational age (LGA) defined as birthweight >90th percentile for gestational age, macrosomia (birthweight ≥4000 grams), shoulder dystocia, hypoglycemia, and admission to neonatal intensive care unit (NICU). A random-effects network meta-analysis was conducted within a frequentist setting to estimate direct and indirect comparisons of treatments in selected trials. Treatments were ranked based on the estimated probability of being the best or least effective. A total of 30 RCTs including 5,299 women-infant pairs were selected for analysis. Metformin compared with insulin resulted in significant reduction of LGA (odds ratio (OR) 0.5; 95% confidence interval (CI); 0.28, 0.91). The rate of neonatal hypoglycemia was significantly higher in the glyburide treated group (Table 1). Metformin and metformin plus insulin compared with insulin and glyburide reduced the rates of neonatal hypoglycemia and NICU admission (Table 1). No significant differences found on the other outcomes between the treatments. Metformin with and without insulin were the best choices for reducing the risk of the selected neonatal outcomes (Table 2). Glyburide ranked as the least effective treatment for all neonatal outcomes, except NICU admission for which insulin ranked as the least effective therapy (Table 2). Due to the association with adverse neonatal effects, glyburide should be considered as the last treatment choice of GDM. Metformin with and without insulin had a favorable short-term neonatal outcome profile.View Large Image Figure ViewerDownload Hi-res image Download (PPT)