Moore Thomas R
Department of Reproductive Medicine, School of Medicine, University of California San Diego, 200 W. Arbor Drive, MPF 170, San Diego, CA 92103, USA.
Diabetes Care. 2007 Jul;30 Suppl 2:S209-13. doi: 10.2337/dc07-s218.
The clinical experience with glyburide treatment of GDM has moved ahead of the science. A single randomized controlled trial of glyburide versus insulin indicates that glyburide treatment can provide a relatively safe alternative to insulin therapy. Subsequent retrospective trials have shown that up to 20% of GDM patients, especially those with substantial pretreatment hyperglycemia, are likely to require adjunctive or alternative therapy with insulin. These follow-on trials have also demonstrated that glyburide treatment, compared with insulin, actually results in lower mean glucose values and a higher percentage of "excellent glycemic control" with fewer hypoglycemic episodes. With the emerging view that glyburide treatment compared with insulin improves glycemic profiles, it should be expected to reduce the frequency of newborn obesity. Larger randomized controlled trials are necessary to clarify this question and the concerns regarding neonatal metabolic morbidity in glyburide-treated offspring.
格列本脲治疗妊娠期糖尿病（GDM）的临床经验已领先于相关科学研究。一项关于格列本脲与胰岛素对比的单一随机对照试验表明，格列本脲治疗可为胰岛素治疗提供相对安全的替代方案。随后的回顾性试验显示，高达20%的GDM患者，尤其是那些治疗前血糖显著升高的患者，可能需要胰岛素辅助治疗或替代治疗。这些后续试验还表明，与胰岛素相比，格列本脲治疗实际上能使平均血糖值更低，“血糖控制良好”的比例更高，且低血糖发作次数更少。鉴于出现了格列本脲治疗与胰岛素相比可改善血糖状况的观点，预计它能降低新生儿肥胖的发生率。需要开展更大规模的随机对照试验来阐明这一问题以及有关格列本脲治疗后代的新生儿代谢并发症的担忧。
