Pharmacologic Treatment of Diabetes in Pregnancy
Conclusions and Relevance
Insulin is the preferred pharmacologic treatment according to ACOG. However, SMFM has stated that outcomes with metformin are similar, and it may also be considered as first-line therapy. Both agree that the available data show that metformin is safer and superior to glyburide, and glyburide is no longer recommended as a first-line therapy for the treatment of gestational diabetes.
Target Audience
Obstetricians and gynecologists, family physicians.
Learning Objectives
After completing this activity, the learner should be better able to compare the maternal/fetal risks associated with glybu...
Source: Obstetrical and Gynecological Survey - May 1, 2019 Category: OBGYN Tags: CME ARTICLES Source Type: research
Detecting Secular Trends in Clinical Treatment through Temporal Analysis
AbstractMedical treatments change over time for multiple reasons, including introduction of new treatments, availability of new scientific evidence, change in institutional guidelines, and market efforts by pharmaceutical and medical device companies. Monitoring and analyzing these secular trends will also inform the evaluation of evidence based practice as well as outcome research. Using a large national clinical dataset from the United States Veterans Health Administration (VHA), we measured the change in prevalence of all diseases, medications, and procedures by year from 2001 to 2014. To assess statistical significance...
Source: Journal of Medical Systems - February 12, 2019 Category: Information Technology Source Type: research
Hot-melt extrusion process impact on polymer choice of Glyburide solid dispersions: The effect of wettability and dissolution
Publication date: Available online 27 January 2019Source: International Journal of PharmaceuticsAuthor(s): Maen Alshafiee, Mohammad K. Aljammal, Daniel Markl, Adam Ward, Karl Walton, Liam Blunt, Sachin Korde, Sudhir K. Pagire, Adrian L. Kelly, Anant Paradkar, Barbara R. Conway, Kofi Asare-AddoAbstractThe aim of this study was to evaluate the choice of polymer and polymer level on the performance of the microstructure and wettability of hot-melt extruded solid dispersion of Glyburide (Gly) as a model drug. The produced solid dispersion were characterised using scanning electron microscopy (SEM), image analysis using a focus...
Source: International Journal of Pharmaceutics - January 28, 2019 Category: Drugs & Pharmacology Source Type: research
Anandamide down-regulates placental transporter expression through CB2 receptor-mediated inhibition of cAMP synthesis
Publication date: Available online 2 January 2019Source: Pharmacological ResearchAuthor(s): John T. Szilagyi, Gabriella M. Composto-Wahler, Laurie B. Joseph, Bingbing Wang, Todd Rosen, Jeffrey D. Laskin, Lauren M. AleksunesAbstractThe BCRP/ABCG2 efflux transporter is expressed on the membrane of placental syncytiotrophoblasts and protects the fetus from toxicant exposure. Syncytiotrophoblasts arise from the fusion of cytotrophoblasts, a process negatively regulated by the endocannabinoid, anandamide (AEA). It is unknown whether AEA can influence fetal concentrations of xenobiotics by modulating the expression of transporte...
Source: Pharmacological Research - January 3, 2019 Category: Drugs & Pharmacology Source Type: research
492: Neonatal outcomes in gestational diabetes managed with insulin vs. glyburide therapy: a cost-effectiveness analysis
To compare neonatal outcomes and assess the cost-effectiveness of insulin therapy versus glyburide therapy in women with gestational diabetes in the context of most recent randomized controlled trials. (Source: American Journal of Obstetrics and Gynecology)
Source: American Journal of Obstetrics and Gynecology - December 25, 2018 Category: OBGYN Authors: Allison J. Munn, Alyssa R. Hersh, Abigail R. Vinson, Thomas D. Brennan, Amy M. Valent, Aaron B. Caughey Tags: Poster Session III Source Type: research
Bladder decompensation and reduction in nerve density in a rat model of chronic bladder outlet obstruction is attenuated with the NLRP3 inhibitor glyburide.
Abstract
Bladder outlet obstruction (BOO) leads to progressive voiding dysfunction. Acutely, obstruction triggers inflammation that drives bladder dysfunction. Over time, inflammation leads to decreased bladder nerve density and increased fibrosis that is responsible for eventual decompensation and irreversibility. We have previously shown that BOO triggers inflammation, reduced bladder nerve density and increased fibrosis via activation of the NLRP3 inflammasome in an acutely obstructed (12 day) rat model. However, as BOO progresses the bladder may become decompensated with an increase in post-void residu...
Source: Am J Physiol Renal P... - October 24, 2018 Category: Urology & Nephrology Authors: Hughes FM, Sexton SJ, Ledig PD, Yun CE, Jin H, Purves JT Tags: Am J Physiol Renal Physiol Source Type: research
Psychiatric Emergencies for Clinicians: Emergency Department Management of Hypercalcemia
A 55-year-old male with a medical history notable for diabetes mellitus and lung cancer was brought to the emergency department via emergency medical services for lethargy and confusion that started a few hours earlier. His family reported that his medications included tramadol 50 mg three times a day as needed for pain and glyburide 5 mg twice a day. A review of systems was taken from his family members, which was positive for nausea, abdominal pain, polyuria, polydipsia, and a recent renal stone. (Source: The Journal of Emergency Medicine)
Source: The Journal of Emergency Medicine - October 15, 2018 Category: Emergency Medicine Authors: Dunya N. Alfaraj, Michael P. Wilson, Yahia Akeely, Gary M. Vilke, Kimberly Nordstrom Tags: Selected Topics Psychiatric Emergencies Source Type: research
Oral antidiabetic agents in gestational diabetes: a narrative review of current evidence.
Authors: Singh AK, Singh R
Abstract
Gestational diabetes mellitus (GDM) classically occurs when maternal glucose metabolism is unable to compensate the progressive development of insulin resistance that arises from the continuously rising diabetogenic placental hormones. Although most women can be treated satisfactorily with diet alone, some require more intensive treatment. Insulin has been the most reliable treatment strategy in GDM over several decades. Although a long time has passed since the publication of two randomized controlled trials suggesting comparable efficacy and safety of metformin and gli...
Source: Expert Review of Endocrinology and Metabolism - October 11, 2018 Category: Endocrinology Tags: Expert Rev Endocrinol Metab Source Type: research
Glyburide vs Insulin for Gestational Diabetes
To the Editor Dr S énat and colleagues conducted a randomized clinical trial investigating the effect of glyburide or insulin on perinatal complications among women with gestational diabetes. We wonder whether the study design can be applied to most women with gestational diabetes. (Source: JAMA)
Source: JAMA - October 2, 2018 Category: General Medicine Source Type: research
Glyburide vs Insulin for Gestational Diabetes —Reply
In Reply Our study included women with singleton pregnancies and gestational diabetes diagnosed between 24 and 34 weeks, since intervention studies have shown efficacy of treatment in preventing perinatal complications in this population. Type 2 diabetes and gestational diabetes diagnosed before 24 weeks were exclusion criteria, so our trial was not designed to compare the efficacy of insulin and glyburide in preventing perinatal complications in women with gestational diabetes before 24 weeks. We did not compare complications in women diagnosed earlier vs later in the 24- to 34-week period. (Source: JAMA)
Source: JAMA - October 2, 2018 Category: General Medicine Source Type: research
Detection of potential look-alike/sound-alike medication errors using Veterans Affairs administrative databases.
CONCLUSION: Through the use of administrative databases, potential LASA errors that could be reviewed for an actual error via chart review were identified. While a high rate of potential LASA errors was detected, the number of actual errors identified was low.
PMID: 30257842 [PubMed - in process] (Source: American Journal of Health-System Pharmacy : AJHP)
Source: American Journal of Health-System Pharmacy : AJHP - September 29, 2018 Category: Drugs & Pharmacology Authors: Zacher JM, Cunningham FE, Zhao X, Burk ML, Moore VR, Good CB, Glassman PA, Aspinall SL Tags: Am J Health Syst Pharm Source Type: research
Oral Agents for the Treatment of Gestational Diabetes
AbstractPurpose of ReviewTo review the current evidence of the safety and efficacy of the use of oral agents for treatment of gestational diabetes (GDM).Recent FindingsThe use of metformin and glyburide in pregnancy for treatment of GDM has dramatically increased since the early 2000s. Meta-analyses suggest that glyburide may increase the risk for large for gestational (LGA) infants and neonatal hypoglycemia. Conversely, metformin may potentially decrease rates of pregnancy-induced hypertension, LGA, neonatal hypoglycemia, and maternal weight gain. However, recent long-term offspring studies indicate a potential detrimenta...
Source: Current Diabetes Reports - September 28, 2018 Category: Endocrinology Source Type: research
Characterization of the cholesterol efflux of apolipoprotein E-containing high-density lipoprotein in THP-1 cells.
Authors: Horiuchi Y, Ohkawa R, Lai SJ, Yamazaki A, Ikoma H, Yano K, Kameda T, Tozuka M
Abstract
High-density lipoprotein (HDL), also known as anti-atherogenic lipoprotein, consists of heterogeneous particles in terms of size, density, and composition, suggesting differences among HDL subclasses in characteristics and functions. We investigated the role of apolipoprotein E (apoE)-containing HDL, a minor HDL subclass, in the cholesterol efflux capacity (CEC) of HDL, which is its predominant atheroprotective function. The CEC of apoE-containing HDL was similar to that of apoE-deficient HDL, but the former exh...
Source: Biological Chemistry - September 14, 2018 Category: Chemistry Tags: Biol Chem Source Type: research
Effect of Glyburide vs Subcutaneous Insulin on Perinatal Complications Among Women With Gestational Diabetes: A Randomized Clinical Trial
(Abstracted from JAMA 2018;319(17):1773–1780)
Gestational diabetes continues to increase nationally and globally. The American Diabetes Association currently recommends insulin, the only Food and Drug Administration–approved pharmacologic agent, as first-line treatment for women with gestational diabetes mellitus requiring medications. (Source: Obstetrical and Gynecological Survey)
Source: Obstetrical and Gynecological Survey - September 1, 2018 Category: OBGYN Tags: Obstetrics: Medical Complications of Pregnancy Source Type: research
