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作者：Laurie Barclay, MD  
出處：WebMD醫學新聞

　　January 7, 2010 — 根據發表於2010年1月號婦產科(Obstetrics Gynecology)期刊的隨機試驗結果，用於妊娠糖尿病(gestational diabetes mellitus[GDM])的治療時，metformin的失敗率是glyburide的近2倍。
　　
　　新墨西哥大學醫學院的Lisa E. Moore醫師等人寫道，研究目標是比較服用metformin和服用glyburide病患在妊娠糖尿病控制的血糖值。我們假設，metformin和glyburide在這個齊頭式比較中，對於血糖控制應有相當的效果。
　　
　　未能藉由飲食達到血糖控制的GDM 婦女，被隨機指派接受metformin (n = 75人)或glyburide (n = 74人)，研究的主要終點是血糖控制，次級終點是藥物失敗率以及新生兒和產科併發症。
　　
　　兩組之間，對於那些達到適當血糖控制者，平均空腹和餐後2小時血糖值沒有統計上的差異，不過，metformin組有26個病患(34.7%)因為血糖控制不佳而需要使用胰島素，glyburide組則有12個病患需要(16.2%；P = .01)。
　　
　　研究作者們寫道，本研究中，用於治療妊娠糖尿病時，metformin的失敗率是glyburide的2.1倍(95%信心區間[CI]，1.2–3.9)。
　　
　　研究限制包括，樣本少且強度不足以表達出次級結果。
　　
　　研究作者結論表示，此研究討論的是使用glyburide和metformin作為單一藥物治療，對於那些需要胰島素的病患，若繼續使用這些藥物當做輔助治療是否有幫助，則需要後續研究確認， 此外，對於懷孕前糖尿病者來說，口服藥物(不論是單用或者和胰島素併用)，都需進行後續研究探討。
　　
　　研究作者們皆宣告沒有相關財務關係。
　　
　　Obstet Gynecol. 2010;115:55-59.  


Metformin May Have Higher Failure Rate Than Glyburide for Gestational Diabetes

By Laurie Barclay, MD
Medscape Medical News

January 7, 2010 — The failure rate of metformin was approximately twice that of glyburide when used in the management of gestational diabetes mellitus (GDM), according to the results of a randomized trial reported in the January 2010 issue of Obstetrics Gynecology.

"The goal of this study was to compare blood glucose levels in patients taking metformin to blood glucose levels in patients taking glyburide for management of gestational diabetes," write Lisa E. Moore, MD, from the University of New Mexico School of Medicine in Albuquerque, and colleagues. "We hypothesized that metformin and glyburide would show equivalent efficacy in controlling blood glucose in a head-to-head comparison."

Women with GDM who did not achieve glycemic control with diet were randomly assigned to receive monotherapy with metformin (n = 75) or glyburide (n = 74). The main endpoint of the study was glycemic control, and secondary endpoints were rate of drug failure and neonatal and obstetric complications.

Mean fasting and 2-hour postprandial blood glucose levels were not statistically different between the 2 groups for those patients who achieved adequate glycemic control. However, insulin treatment was required for inadequate glycemic control in 26 patients in the metformin group (34.7%) vs 12 patients in the glyburide group (16.2%; P = .01).

"In this study, the failure rate of metformin was 2.1 times higher than the failure rate of glyburide when used in the management of gestational diabetes (95% confidence interval [CI], 1.2–3.9)," the study authors write.

Limitations of this study include small size and insufficient power to address secondary outcomes.

"This study addressed the use of glyburide and metformin as single-agent therapies," the study authors conclude. "Future studies are needed to determine whether there is a benefit in continuing these agents as adjuvant therapies in patients requiring insulin. In addition, the role of oral agents in patients with pregestational diabetes either as single agents or in combination with insulin needs to be addressed in future studies."

The study authors have disclosed no relevant financial relationships.

Obstet Gynecol. 2010;115:55-59.