Resumen
Introducción: La diabetes gestacional es una alteración de la tolerancia a la glucosa de severidad variable reconocida por primera vez en el embarazo en curso. La insulina ha sido el tratamiento farmacológico estándar para la diabetes gestacional, sin embargo la metformina y la gliburida son alternativas terapéuticas para el control de la glicemia. Objetivo: Determinar las ventajas de la metformina y la gliburida sobre la insulina en el tratamiento de la diabetes gestacional. Materiales y métodos: Se realizó una búsqueda sistemática en las bases de datos Medline (PubMed) y Scielo. Los términos DeCS utilizados fueron: “Diabetes Gestacional”, “Gliburida”, y “Metformina” en diferentes combinaciones; sus homólogos MeSH fueron: “Diabetes, Gestational”, “Glyburide” y “Metformin”. La búsqueda obtenida incluyó 130 artículos, de los cuáles fueron seleccionados 53. Resultados: La gliburida es un medicamento categoría C en el embarazo. Sus concentraciones en cordón umbilical son insignificantes y es considerado seguro. Su tasa de éxito para lograr el control de la glicemia c varía del 79% al 86%. La metformina es un medicamento categoría B en el embarazo. No ha mostrado efectos teratógenos en el primer trimestre del embarazo y logra un control de la glicemia en 24 horas. Conclusiones: La metformina y la gliburida logran valores de control de glicemia en diabetes gestacional similares a la insulina y no aumentan la teratogénesis en el primer trimestre del embarazo. Las complicaciones perinatales por su uso deben ser más estudiadas. MÉD UIS. 2015;28(3):337-43.
Palabras clave: Diabetes gestacional. Metformina. Gliburida.
Referencias
1. Berggren E, Boggess K. Oral agents for the management of gestational diabetes. Clin Obstet Gynecol. 2013;56: 827-836.
2. Kim, S.Y., England, L., Wilson, H.G., Bish, C., Satten, G.A., and Dietz, P. Percentage of gestational diabetes mellitus attributable to overweight and obesity. Am J Public Health. 2010; 100: 1047–1052.
3. Paglia MJ, Coustan DR. The use of oral antidiabetic medications in gestational diabetes mellitus. Curr Diabetes Rep. 2009;9: 287-290.
4. Gui J, Liu Q, Feng L. Metformin vs insulin in the management of gestational diabetes: a meta-analysis. PLOS ONE 2013; 8(5): e64585.
5. American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care 2011;34 (Suppl. 1): S62-S69.
6. Gómez G, Mesa J. Diabetes y Embarazo. Evaluación del programa en la consulta de endocrinología del Hospital Universitario del Valle 1989-1996. Rev Colomb Obstet Ginecol. 1997;48(4): 239-42.
7. Cortés H, Ocampo I, Villegas A. Prevalencia de diabetes mellitus gestacional en una población de Medellín de 1999 - 2000: valor predictivo positivo de la prueba tamiz y comparación de los criterios de la NDDG y la ADA. Rev Colomb Obstet Ginecol. 2002;53(1):81–5.
8. American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care 2010;33(Suppl. 1):S62-S69.
9. American Diabetes Association. The American Diabetes Association (ADA) has been actively involved in the development and dissemination of diabetes care standards, guidelines, and related documents for many years. Introduction. Diabetes Care. 2009;32Suppl 1 :S1–2.
10. Metzger BE, Lowe LP, Dyer AR, Trimble ER, Chaovarindr U, Coustan DR, et al. Hyperglycemia and adverse pregnancyoutcomes. N Engl J Med 2008;358:1991–2002.
11. Donovan L. Screening tests for gestational diabetes: a systematic review for the US preventive services task force. Ann Intern Med 2013;159(2):115-22.
12. Maymone AC, Baillargeon JP, Menard J, Ardilouze JL. Oral hypoglycemic agents for gestational diabetes mellitus? Expert Opin Drug Saf. 2011;10(2): 227-238.
13. Dempsey JC, Butler CL, Sorensen TK, Lee IM, Thompson ML, et al. A case-control study of maternal recreational physical activity and risk of gestational diabetes mellitus. Diabetes Res Clin Pract. 2004;66: 203–215.
14. Ben-Haroush A, Yogev Y, Hod M. Epidemiology of gestational diabetes mellitus and its association with Type 2 diabetes. Diabet Med. 2004;21(2): 103–113.
15. Rowan JA, Gao W, Hague WM, McIntyre HD. Glycemia and its relation ship to out comes in the diabetes trial. Diabetes Care. 2010;33(1): 9–16.
16. de Veciana M, Major CA, Morgan MA, Asrat T, Toohey JS, Lien JM, et al. Postprandial versus preprandial blood glucose monitoring in women with gestational diabetes mellitus requiring insulin therapy. N Engl J Med. 1995;333(19): 1237–1241.
17. Esakoff TF, Cheng YW, Sparks TN, Caughey AB. The association between birthweight 4000 g or greater and perinatal outcomes in patients with and without gestational diabetes mellitus. Am J Obstet Gynecol. 2009;200(6):672.
18. American College of Obstetricians and Gynecologists Committee on Practice Bulletins—Obstetrics. ACOG Practice Bulletin, authors. Clinical management guidelines for obstetrician-gynecologists. Number 30, September 2001. Gestational diabetes. Obstet Gynecol. 2001;98: 525–538.
19. Crowther CA, Hiller JE, Moss JR, McPhee AJ, Jeffries WS, Robinson JS. Effect of Treatment of Gestational Diabetes Mellitus on Pregnancy Outcomes. N Engl J Med. 2005;352: 2477-2486.
20. Refuerzo JS. Oral hypoglycemic agents in pregnacy. Obstet Gynecol Clin North Am. 2011;38: 227-234.
21. Norman RJ, Wang JX, Hague W. Should we continue or stop insulin sensitizing drugs during pregnancy? Curr Opin Obstet Gynecol. 2004: 16: 245-250.
22. Rowan JA, Hague WM, Gao W, Battin MR, Moore MP. Metformin versus insulin for the treatment of gestational diabetes. N Engl J Med. 2008;358: 2003–2015.
23. Lautatzis M, Goulis D, Vrontakis M. Efficacy and safety of metformin during pregnancy in women with gestational diabetes mellitus or polycystic ovary syndrome: a systematic review. Metabolism. 2013;62 (11): 1522-1534.
24. Poolsup N, Suksomboon N, Amin M. Efficacy and Safety of Oral Antidiabetic Drugs in Comparison to Insulin in Treating Gestational Diabetes Mellitus: A Meta-Analysis. PLoSOne. 2014;10;9(10):e109985.
25. Aguilar-Bryan L, Nichols CG, Wechsler SW, Clement JP 4th, Boyd AE 3rd, González G, et al. Cloning of the beta cell high-affinity sulfonylurea receptor: a regulator of insulin secretion. Science. 1995;268(5209): 423-426.
26. Bressler R, Johnson DG. Pharmacological regulation of blood glucose levels in non-insulin-dependent diabetes mellitus. Arch Intern Med. 1997; 157:836.
27. Rydberg T; Jonsson A, Roder M, Melander A. Hypoglycemic activity of glyburide (glibencalmide) metabolites in humans. Diabetes Care. 1997;17:1026-1030.
28. DeFronzo RA, Simonson DC. Oral sulfonylurea agents suppress hepatic glucose production in non-insulin-dependent diabetic individuals. Diabetes Care. 1984;7:72-80.
29. Hebert M, Ma X, Naraharisetti S, Krudys K, Umans J, Hankins G, et al. Are we optimizing gestational diabetes treatment with glyburide? The pharmacologic basis for better clinical practice. Clin Pharmacol Ther. 2009; 85: 607–614.
30. Prendergast B. Glyburide and glipizide, second-generation oral sulfonylurea hypoglycemic agents. ClinPharm. 1984;3(5): 473-485.
31. Merlob P, Levitt O, Stahl B. Oral antihyperglycemic agents during pregnancy and lactation: a review. Paediatr Drugs. 2002;4: 755-760.
32. Sivan E, Feldman B, Dolitzki M, Nevo N, Dekel N, Karasik A. Glyburide crosses the placenta in vivo in pregnant rats. Diabetologia. 1995;38: 753-756.
33. Elliott BD, Langer O, Schenker S, Johnson RF. Insignificant transfer of glyburide occurs across the human placenta. Am J Obstet Gynecol. 1991;165: 807-12.
34. Koren G. Glyburide and fetal safety; transplacental pharmacokinetic considerations. Reprod Toxicol. 2001;15(3): 227–229.
35. Garcia-Boursenissen F, Feig D, Koren G. Maternal-fetal transport of hypoglycemic drugs. Clin Pharmacokinet. 2003;42(4): 303-313.
36. Bertini AM, Silva JC, Taborda W, Becker F, LemosBebber FR, ZuccoViesi JM, et al. Perinatal outcomes and the use of oral hypoglycemicagents. J PerinatMed. 2005;33(6):519-23.
37. Jacobson GF, Ramos GA, Ching JY, Kirby RS, Ferrara A, Field DR. Comparison of glyburide and insulin for the management of gestational diabetes in a large managed care organization. Am J Obstet Gynecol. 2005;193(1): 118-24.
38. Kahn BF, Davies JK, Lynch AM, Reynolds RM, Barbour LA. Predictors of glyburide failure in the treatment of gestational diabetes. Obstet Gynecol. Jun 2006;107(6): 1303-1309.
39. Rochon M, Rand L, Roth L, Gaddipati S. Glyburide for the management of gestational diabetes: risk factors predictive of failure and associated pregnancy out comes. Am J Obstet Gynecol. 2006;195(4): 1090-1094.
40. Langer O, Conway DL, Berkus MD, Xenakis EM, Gonzales O. A comparison of glyburide and insulin in women with gestational diabetes mellitus. N Engl J Med. 2000;343: 1134-38.
41. Conway D, Gonzales O, Skiver D. Use of glyburide for the treatment of gestational diabetes: the San Antonio experience. Obstet Gynecol Surv. 2004;59(7): 491.
42. Tempe A, Mayanglambam R. Glyburide as treatment option for gestational diabetes mellitus. J Obstet Gynecol. 2013;39(6):1147–52.
43. Goh J, Sadler L, Rowan J. Metformin for gestational diabetes in routine clinical practice. Diabet Med. 2011;28(9):1082-87.
44. Ballas J, Moore T, Ramos G. Management of diabetes in pregnancy. Curr Diab Rep. 2012;12: 33-42.
45. Eyal S, Easterling TR, Carr D. Pharmacokinetics of metformin during pregnancy. Drug Metab Dispos. 2010:13:257-62.
46. Bailey C. Metformin: a multitasking medication. Diab Vasc Dis Res. 2008;5(3): 156.
47. Coetzee E, Jackson W. Pregnancy in established non-insulin-dependentdiabetics. A five and a half year study at Groote Schuur Hospital. S Afr Med J. 1980;58(20): 785-802.
48. Moore L, Clokey D, Rappaport V, Curet L. Metformin compared with glyburide in gestational diabetes. Obstet Gynecol. 2010;115: 55–9.
49. Feig DS, Moses RG. Metformin therapy during pregnancy: Good for the goose and good for the gosling too? Diabetes Care. 2011;34:2329–30.
50. Rowan JA, Rush EC, Obolonkin V, Battin M, Wouldes T, Hague WM. Metformin in Gestational diabetes: The Offspring Follow-Up (MiG TOFU): body composition at 2 years of age. Diabetes Care. 2011;34:2279–84
51. Silva J, Pacheco C, Bizato J. Metformin compared with glyburide for the management of gestational diabetes. Obstet Gynecol. 2010;111: 37–40.
52. Ekpebegh CO, Coetzee EJ, Van der Merwe L, Levitt NS. A 10-year retrospective analysis of pregnancy outcome in pregestational type 2 diabetes: comparison of insulin and oral glucose-lowering agents. Diabet Med. 2007;24:253–8
53. Gutzin SJ, Kozer E, Magee LA, Feig DS, Koren G. The safety of oral hypoglycemic agents in the first trimester of pregnancy: a meta-analysis. Can J Clin Pharmacol 2003;10:179–83
2. Kim, S.Y., England, L., Wilson, H.G., Bish, C., Satten, G.A., and Dietz, P. Percentage of gestational diabetes mellitus attributable to overweight and obesity. Am J Public Health. 2010; 100: 1047–1052.
3. Paglia MJ, Coustan DR. The use of oral antidiabetic medications in gestational diabetes mellitus. Curr Diabetes Rep. 2009;9: 287-290.
4. Gui J, Liu Q, Feng L. Metformin vs insulin in the management of gestational diabetes: a meta-analysis. PLOS ONE 2013; 8(5): e64585.
5. American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care 2011;34 (Suppl. 1): S62-S69.
6. Gómez G, Mesa J. Diabetes y Embarazo. Evaluación del programa en la consulta de endocrinología del Hospital Universitario del Valle 1989-1996. Rev Colomb Obstet Ginecol. 1997;48(4): 239-42.
7. Cortés H, Ocampo I, Villegas A. Prevalencia de diabetes mellitus gestacional en una población de Medellín de 1999 - 2000: valor predictivo positivo de la prueba tamiz y comparación de los criterios de la NDDG y la ADA. Rev Colomb Obstet Ginecol. 2002;53(1):81–5.
8. American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care 2010;33(Suppl. 1):S62-S69.
9. American Diabetes Association. The American Diabetes Association (ADA) has been actively involved in the development and dissemination of diabetes care standards, guidelines, and related documents for many years. Introduction. Diabetes Care. 2009;32Suppl 1 :S1–2.
10. Metzger BE, Lowe LP, Dyer AR, Trimble ER, Chaovarindr U, Coustan DR, et al. Hyperglycemia and adverse pregnancyoutcomes. N Engl J Med 2008;358:1991–2002.
11. Donovan L. Screening tests for gestational diabetes: a systematic review for the US preventive services task force. Ann Intern Med 2013;159(2):115-22.
12. Maymone AC, Baillargeon JP, Menard J, Ardilouze JL. Oral hypoglycemic agents for gestational diabetes mellitus? Expert Opin Drug Saf. 2011;10(2): 227-238.
13. Dempsey JC, Butler CL, Sorensen TK, Lee IM, Thompson ML, et al. A case-control study of maternal recreational physical activity and risk of gestational diabetes mellitus. Diabetes Res Clin Pract. 2004;66: 203–215.
14. Ben-Haroush A, Yogev Y, Hod M. Epidemiology of gestational diabetes mellitus and its association with Type 2 diabetes. Diabet Med. 2004;21(2): 103–113.
15. Rowan JA, Gao W, Hague WM, McIntyre HD. Glycemia and its relation ship to out comes in the diabetes trial. Diabetes Care. 2010;33(1): 9–16.
16. de Veciana M, Major CA, Morgan MA, Asrat T, Toohey JS, Lien JM, et al. Postprandial versus preprandial blood glucose monitoring in women with gestational diabetes mellitus requiring insulin therapy. N Engl J Med. 1995;333(19): 1237–1241.
17. Esakoff TF, Cheng YW, Sparks TN, Caughey AB. The association between birthweight 4000 g or greater and perinatal outcomes in patients with and without gestational diabetes mellitus. Am J Obstet Gynecol. 2009;200(6):672.
18. American College of Obstetricians and Gynecologists Committee on Practice Bulletins—Obstetrics. ACOG Practice Bulletin, authors. Clinical management guidelines for obstetrician-gynecologists. Number 30, September 2001. Gestational diabetes. Obstet Gynecol. 2001;98: 525–538.
19. Crowther CA, Hiller JE, Moss JR, McPhee AJ, Jeffries WS, Robinson JS. Effect of Treatment of Gestational Diabetes Mellitus on Pregnancy Outcomes. N Engl J Med. 2005;352: 2477-2486.
20. Refuerzo JS. Oral hypoglycemic agents in pregnacy. Obstet Gynecol Clin North Am. 2011;38: 227-234.
21. Norman RJ, Wang JX, Hague W. Should we continue or stop insulin sensitizing drugs during pregnancy? Curr Opin Obstet Gynecol. 2004: 16: 245-250.
22. Rowan JA, Hague WM, Gao W, Battin MR, Moore MP. Metformin versus insulin for the treatment of gestational diabetes. N Engl J Med. 2008;358: 2003–2015.
23. Lautatzis M, Goulis D, Vrontakis M. Efficacy and safety of metformin during pregnancy in women with gestational diabetes mellitus or polycystic ovary syndrome: a systematic review. Metabolism. 2013;62 (11): 1522-1534.
24. Poolsup N, Suksomboon N, Amin M. Efficacy and Safety of Oral Antidiabetic Drugs in Comparison to Insulin in Treating Gestational Diabetes Mellitus: A Meta-Analysis. PLoSOne. 2014;10;9(10):e109985.
25. Aguilar-Bryan L, Nichols CG, Wechsler SW, Clement JP 4th, Boyd AE 3rd, González G, et al. Cloning of the beta cell high-affinity sulfonylurea receptor: a regulator of insulin secretion. Science. 1995;268(5209): 423-426.
26. Bressler R, Johnson DG. Pharmacological regulation of blood glucose levels in non-insulin-dependent diabetes mellitus. Arch Intern Med. 1997; 157:836.
27. Rydberg T; Jonsson A, Roder M, Melander A. Hypoglycemic activity of glyburide (glibencalmide) metabolites in humans. Diabetes Care. 1997;17:1026-1030.
28. DeFronzo RA, Simonson DC. Oral sulfonylurea agents suppress hepatic glucose production in non-insulin-dependent diabetic individuals. Diabetes Care. 1984;7:72-80.
29. Hebert M, Ma X, Naraharisetti S, Krudys K, Umans J, Hankins G, et al. Are we optimizing gestational diabetes treatment with glyburide? The pharmacologic basis for better clinical practice. Clin Pharmacol Ther. 2009; 85: 607–614.
30. Prendergast B. Glyburide and glipizide, second-generation oral sulfonylurea hypoglycemic agents. ClinPharm. 1984;3(5): 473-485.
31. Merlob P, Levitt O, Stahl B. Oral antihyperglycemic agents during pregnancy and lactation: a review. Paediatr Drugs. 2002;4: 755-760.
32. Sivan E, Feldman B, Dolitzki M, Nevo N, Dekel N, Karasik A. Glyburide crosses the placenta in vivo in pregnant rats. Diabetologia. 1995;38: 753-756.
33. Elliott BD, Langer O, Schenker S, Johnson RF. Insignificant transfer of glyburide occurs across the human placenta. Am J Obstet Gynecol. 1991;165: 807-12.
34. Koren G. Glyburide and fetal safety; transplacental pharmacokinetic considerations. Reprod Toxicol. 2001;15(3): 227–229.
35. Garcia-Boursenissen F, Feig D, Koren G. Maternal-fetal transport of hypoglycemic drugs. Clin Pharmacokinet. 2003;42(4): 303-313.
36. Bertini AM, Silva JC, Taborda W, Becker F, LemosBebber FR, ZuccoViesi JM, et al. Perinatal outcomes and the use of oral hypoglycemicagents. J PerinatMed. 2005;33(6):519-23.
37. Jacobson GF, Ramos GA, Ching JY, Kirby RS, Ferrara A, Field DR. Comparison of glyburide and insulin for the management of gestational diabetes in a large managed care organization. Am J Obstet Gynecol. 2005;193(1): 118-24.
38. Kahn BF, Davies JK, Lynch AM, Reynolds RM, Barbour LA. Predictors of glyburide failure in the treatment of gestational diabetes. Obstet Gynecol. Jun 2006;107(6): 1303-1309.
39. Rochon M, Rand L, Roth L, Gaddipati S. Glyburide for the management of gestational diabetes: risk factors predictive of failure and associated pregnancy out comes. Am J Obstet Gynecol. 2006;195(4): 1090-1094.
40. Langer O, Conway DL, Berkus MD, Xenakis EM, Gonzales O. A comparison of glyburide and insulin in women with gestational diabetes mellitus. N Engl J Med. 2000;343: 1134-38.
41. Conway D, Gonzales O, Skiver D. Use of glyburide for the treatment of gestational diabetes: the San Antonio experience. Obstet Gynecol Surv. 2004;59(7): 491.
42. Tempe A, Mayanglambam R. Glyburide as treatment option for gestational diabetes mellitus. J Obstet Gynecol. 2013;39(6):1147–52.
43. Goh J, Sadler L, Rowan J. Metformin for gestational diabetes in routine clinical practice. Diabet Med. 2011;28(9):1082-87.
44. Ballas J, Moore T, Ramos G. Management of diabetes in pregnancy. Curr Diab Rep. 2012;12: 33-42.
45. Eyal S, Easterling TR, Carr D. Pharmacokinetics of metformin during pregnancy. Drug Metab Dispos. 2010:13:257-62.
46. Bailey C. Metformin: a multitasking medication. Diab Vasc Dis Res. 2008;5(3): 156.
47. Coetzee E, Jackson W. Pregnancy in established non-insulin-dependentdiabetics. A five and a half year study at Groote Schuur Hospital. S Afr Med J. 1980;58(20): 785-802.
48. Moore L, Clokey D, Rappaport V, Curet L. Metformin compared with glyburide in gestational diabetes. Obstet Gynecol. 2010;115: 55–9.
49. Feig DS, Moses RG. Metformin therapy during pregnancy: Good for the goose and good for the gosling too? Diabetes Care. 2011;34:2329–30.
50. Rowan JA, Rush EC, Obolonkin V, Battin M, Wouldes T, Hague WM. Metformin in Gestational diabetes: The Offspring Follow-Up (MiG TOFU): body composition at 2 years of age. Diabetes Care. 2011;34:2279–84
51. Silva J, Pacheco C, Bizato J. Metformin compared with glyburide for the management of gestational diabetes. Obstet Gynecol. 2010;111: 37–40.
52. Ekpebegh CO, Coetzee EJ, Van der Merwe L, Levitt NS. A 10-year retrospective analysis of pregnancy outcome in pregestational type 2 diabetes: comparison of insulin and oral glucose-lowering agents. Diabet Med. 2007;24:253–8
53. Gutzin SJ, Kozer E, Magee LA, Feig DS, Koren G. The safety of oral hypoglycemic agents in the first trimester of pregnancy: a meta-analysis. Can J Clin Pharmacol 2003;10:179–83
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