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Re: Glyburide From: Efrain Ramirez (eramirezt@coqui.net) Wed Mar 23 18:08:13 2005 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Efrain Ramirez: "Re: uterine adhesions to post per. wall" Previous message: Garry E. Siegel, M.D.: "Re: GEN: Hypothyroidism" In reply to: Garry E. Siegel, M.D.: "Re: Glyburide" Thanks guys - anyway - fetal testing should be the same as a patient using insulin or kryptonite - in my view - As it becomes more widely used the following should change: "CLINICAL MANAGEMENT GUIDELINES FOR OBSTETRICIAN—GYNECOLOGISTS NUMBER 60, MARCH Pregestational Diabetes Mellitus Is there a role for oral hypoglycemic agents in pregnancy? Oral hypoglycemic agents, used widely in the treatment of nonpregnant patients, have not been well studied in pregnancy (67). However, glyburide, a second-generation sulfonylurea, does not cross the placenta and has been used to treat GDM. Its onset of action is approximately 4 hours and its duration of action is approximately 10 hours. In a study of 404 pregnant women with treatment initiated between 11 and 33 weeks of gestation, glyburide was found to be comparable to insulin in improving glucose control without evidence of adverse maternal and neonatal complications. Metformin has been used as a treatment for infertility in polycystic ovary syndrome (68). Metformin is a category B drug, and although there are more reports of its use during pregnancy (69), the long-term effects of in utero exposure have not been well studied. The use of all oral agents for control of type 2 diabetes mellitus during pregnancy should be limited and individualized until data regarding the safety and efficacy of these drugs become available. " Summary of Recommendations and Conclusions The following recommendations are based on limited or inconsistent scientific evidence (Level B): ..... The use of oral agents for control of type 2 diabetes mellitus during pregnancy should be limited and individualized until data regarding the safety and efficacy of these drugs become available. " >At Wed, 23 Mar 2005, Garry E. Siegel, M.D. wrote: > >I have used it a bit, and am converting to this as first line if diet >fails. > >Personally, I do start fetal surveillance and deliver by 39, maybe 40 >weeks tops. > >Garry > >At Wed, 23 Mar 2005, Elrod Darryl G MAJ 48 MDOS/SGOBO wrote: >> >>Lynn, >> >>Do you test them as you would an A2 on insulin? Do you still recommend >>delivery at or about 39 weeks? >> >>Thanks, >> >>Glen >> >>________________________________ >> >>________________________________ >>________________________________ >>From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Lynn >> >>-- >>________________________________ >>D. Montgomery, M.D. >>________________________________ >>________________________________ >>Sent: Wednesday, March 23, 2005 5:47 PM >>To: Multiple recipients of list OB-GYN-L >>Subject: Glyburide >> >>I have been using it for several years. The South Africans have been >>using the oral hypoglycemics for many years and have good data on them. >>In this country, Langer, et al, who was in San Antonio and now New York, >>did great work using a placental model and demonstrated its relative >>safety. >> >>I start out with 5 mg per day and increase to a max of 20 mg per day, >>then if further control is needed, change over to insulin. There is at >>least one paper recently where they added insulin to the Glyburide. I >>haven't done that. >> >>Interesting note on a couple of papers at the Society meeting last month >>that addressed Glyburide therapy was that there seemed to be an >>increased incidence of patients using Glyburide therapy developing >>preeclampsia late in pregnancy. Obviously small studies and difficult >>to sort through the issue that this subset of patients may be at >>increased risk of developing preeclampsia. The standard line fits: This >>needs to be looked at in a larger population. >> >>Lynn >> >>Lynn D. Montgomery, M.D. >> >>Maternal-Fetal Medicine, OB/GYN >> >>Rocky Mountain Women's Health >> >>2835 Fort Missoula Rd., Suite 304 >> >>Missoula, Montana, 59804 >> >>406-549-0978 >> >>fax 406-549-0987 >> >>e-mail: apgar10@montanadsl.net >> >-- >Garry E. Siegel, M.D. >Private Practice >Roswell, GA > -- I think I will do nothing for a long time but listen, And accrue what I hear into myself...and let sounds contribute toward me. ~walt whitman~ Next message: Efrain Ramirez: "Re: uterine adhesions to post per. wall" Previous message: Garry E. Siegel, M.D.: "Re: GEN: Hypothyroidism" In reply to: Garry E. Siegel, M.D.: "Re: Glyburide"

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