The Safety And Efficiency Of Metformin And Glyburide In Gestational Diabetes Mellitus: Network Meta-analysis

Objective: We performed this network meta-analysis, and tried toanswer whether it is proper for gestational diabetes mellitus withmetformin or glyburide besides insulin. Compared with insulin, weassessed the safety and efficiency of metformin and glyburide in gestationaldiabetes mellitus. Methods: Relevant studies published before December,2013we searched from PubMed, EMBASE, the Cochrane Central Registerof Controlled Trials (CENTRAL), and Chinese biomedicine (CBM)literature database. The safety and efficiency between metformin andglyburide was assessed using direct and indirect results through R softwareand Stata release10. Main results: A total of2,665participants wereidentified in this meta-analysis. These studies provided adjusted ORs (oddisratio) estimated for macrosomia, leading to an adjusted direct OR of3.299(95%CI=1.649to6.600, P=0.001) between glyburide and insulin,and of0.234(95%CI=0.061to0.893, P=0.033) between metformin andglyburide, no difference between metformin group and insulin group(P=0.198). Maternal weight gain was lower in metformin than insulin(P=0.009). The standardized mean difference of-0.142(95%CI=-0.246to -0.039, P=0.007) was estimated for gestational age in the treatment ofmetformin versus insulin. Conclusions: Metformin has a good bloodcontrol, less maternal weight gain, lower neonatal hypoglycemia, glucosetargets reached sooner, and get a significantly lower glycosylatedhemoglobin level without maternal hypoglycaemia, but significant shortengestational age. There was significantly more macrosomia in glyburide.