|
|
 |
 |
 |
|
|
|||
|
||||
|
||||
Re: GDM A2From: GIN11153@aol.comWed Apr 29 01:44:38 2009
Glyburide for the Treatment of Gestational Diabetes Glyburide is an oral medication of the sulfonyl-urea class used to lower blood sugar. The drug acts by stimulating pancreatic islet cells to increase insulin secretion. Glyburide is highly bound to proteins in the blood. The action of glyburide may be enhanced by other drugs that are also highly protein bound such as beta blockers. Pfizer lists glyburide (Micronase ®) as a pregnancy category B drug [1]. Other manufacturers list the drug as category C. Glyburide does not cross the human placenta or enter human breast milk in appreciable quantities [2-4]. Glyburide appears to be a safe and effective alternative to insulin in the treatment of gestational diabetes for some women. However, patients with diabetes prior to pregnancy, a history of diabetic ketoacidosis, liver disease, or a fasting blood sugar greater than or equal to 140 mg/dL are treated more appropriately with insulin [5-9]. Women with an OGTT less than 200 mg/dL, a fasting blood sugar less than 110 mg/dL, and who fail dietary therapy after 30 weeks gestation do well on glyburide therapy [9-12]. The most commonly reported adverse events in patients taking glyburide have been nausea, heart burn, low blood sugar, muscle pain, joint pain, and allergic skin reactions including angioedema (swelling similar to hives) . Blurred vision has been reported with glyburide which is thought to be related to unstable blood sugar values. Liver problems including jaundice and hepatitis may also occur. Less commonly porphyria cutanea tarda, an abnormal sensitivity of the skin to sunlight, hyponatremia, a decrease in the number of agranulocyte white cells in the blood, thrombocytopenia, hemolytic anemia, aplastic anemia, and pancytopenia have been reported with sulfonylureas. Disulfiram-like reactions have been reported very rarely.[1] Patients treated with glyburide for the control of gestational diabetes are classified as type A2 diabetes, and should receive the same antenatal surveillance as patients with A2 diabetes treated with insulin. REFERENCES 1. Micronase® package insert 2002 _www.pfizer.com/pfizer/download/uspi_micronase.pdf_ (http://www.pfizer.com/pfizer/download/uspi_micronase.pdf) . Accessed 5/18/2007 2. Elliott BD, Langer O, Schenker S, Johnson RF. Insignificant transfer of glyburide occurs across the human placenta. Am J Obstet Gynecol 1991;165:807-812 PMID:_ 1951536_ (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&list_uids51536&dopt«stract) 3. Elliott BD, et al Comparative placental transport of oral hypoglycemic agents in humans: a model of human placental drug transfer. Am J Obstet Gynecol. 1994;171:653-60. PMID: _8092211_ (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&list_uids€92211&dopt«stract) 4. Feig DS, Briggs GG, Kraemer JM et al. Transfer of glyburide and glipizide into breast milk. Diabetes Care. 2005;28:1851-5. PMID:_ 16043722_ (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&list_uids0 43722&dopt«stract) 5. ACOG Practice Bulletin. Clinical management guidelines for obstetrician-gynecologists. Number 30, September 2001.Gestational diabetes. Obstet Gynecol. 2001;98:525-38. PMID:_11547793_ (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&list_uids547793&dopt«stract) 6.Langer O, Conway DL, Berkus MD, Xenakis EM-J, Gonzalez O.A comparison of glyburide and insulin in women with gestational diabetes mellitus. N Engl J Med. 2000 ;343:1134-8.PMID: _11036118_ (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&list_uids036118&dopt«stract) 7. Jacobson GF, et al. Comparison of glyburide and insulin for the management of gestational diabetes in a large managed care organization. Am J Obstet Gynecol. 2005 Jul;193(1):118-24. PMID: _16021069_ (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&list_uids021069&dopt«stra ct) 8. Langer O, et al. Insulin and glyburide therapy: dosage, severity level of gestational diabetes, and pregnancy outcome. Am J Obstet Gynecol.2005;192:134-9. PMID: _15672015 _ (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&list_uids672015&dopt«stract) 9. Kahn BF, et al., Predictors of glyburide failure in the treatment of gestational diabetes. Obstet Gynecol.2006;107:1303-9. PMID: _16738156_ (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&list_uids7 38156&dopt«stract) 10. Rochon M , et al.,Glyburide for the management of gestational diabetes: risk factors predictive of failure and associated pregnancy outcomes. Am J Obstet Gynecol. 2006 ;195:1090-4. PMID: _17000241 _ (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&list_uids000241&dopt«st ract) 11. Conway DL , et al., Use of glyburide for the treatment of gestational diabetes: the San Antonio experience. J Matern Fetal Neonatal Med. 2004 ;15:51-5. PMID:_15101612_ (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&list_uids101612&dopt«stract) 12.Chmait R, et al. Prospective observational study to establish predictors of glyburide success in women with gestational diabetes mellitus. J Perinatol. 2004;24:617-22. PMID: _15152273_ (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&list_uids152273&dopt«stract) _http://www.obfocus.com/high-risk/glyburide.htm Gail Neuman RNC CPHW Administrator/student midwife Orange County Maternity Center 1210 S. State College Blvd. Suite D Anaheim, CA 92806 _ (http://www.obfocus.com/high-risk/glyburide.htm) l?redir=http:%2F%2Fad.double click.net%2Fclk%3B214101948%3B35952020%3Bv)
|
|
Return to
|
Mail a New Message to the Forum: ob-gyn-l@obgyn.net Forum Administrator: geffrey.klein@obgyn.net Report Technical Problems: webmaster@obgyn.net Last Updated: Wed Dec 2 05:13:37 2009 |
The American Medical Association is no longer designating CME hours for AMA Category II CME credit. However, physicians themselves may self designate learning activities as Category II CME credit hours if they feel it is of sufficient educational merit and meets the formal definitions of continuing medical education. OBGYN.net believes these interaction in this forum meets these criteria. For further information see the AMA web site.