Yogev Yariv, Melamed Nir, Chen Rony, Nassie Daniel, Pardo Joseph, Hod Moshe
Department of Obstetrics and Gynecology, Helen Schneider Hospital for Women, Rabin Medical Center, Petah Tiqwa, Israel.
J Matern Fetal Neonatal Med. 2011 Jun;24(6):842-6. doi: 10.3109/14767058.2010.531323. Epub 2010 Nov 10.
To identify factors predicting failure of glyburide treatment in women with gestational diabetes mellitus (GDM).
A retrospective study of all women with GDM that were treated with glyburide in a single tertiary referral center. Patients were switched from glyburide to insulin if they failed to achieve glycemic goals, and were then classified as glyburide failure.
Overall, 124 women with GDM treated with glyburide were included in the study, of which 31 (25%) failed to achieve glycemic control. Women in the failure group were characterized by a higher weight gain during pregnancy, higher rates of GDM on previous pregnancies, and a glucose challenge test (GCT) result. On multivariate logistic regression analysis, a GCT value of >200 mg/dl (OR = 7.1, 95% CI 2.8-27.6) and weight gain ≥ 12 kg (OR = 3.9, 95% CI 1.2-13.0) were the only significant and independent predictors of glyburide failure. Most women who were successfully treated with glyburide required a daily dose of 5 mg or less and the time required to achieve glycemic control in these cases was 12.4 ± 4.9 days (range 5-24 days). Of the women who failed to achieve glycemic control with gluburide, 26/31 were switched to insulin, of them only 12 (46%) achieved desired level of glycemic control.
Most women with GDM achieved desired level of glycemic control under glyburide treatment.
确定预测妊娠糖尿病（GDM）女性格列本脲治疗失败的因素。
对在单一三级转诊中心接受格列本脲治疗的所有GDM女性进行回顾性研究。如果患者未达到血糖目标，则从格列本脲转换为胰岛素治疗，然后将其分类为格列本脲治疗失败。
总体而言，124例接受格列本脲治疗的GDM女性纳入研究，其中31例（25%）未达到血糖控制。治疗失败组的女性具有孕期体重增加更多、既往妊娠GDM发生率更高以及葡萄糖耐量试验（GCT）结果等特征。多因素逻辑回归分析显示，GCT值>200 mg/dl（OR = 7.1，95%CI 2.8 - 27.6）和体重增加≥12 kg（OR = 3.9，95%CI 1.2 - 13.0）是格列本脲治疗失败仅有的显著且独立的预测因素。大多数成功接受格列本脲治疗的女性每日剂量需要5 mg或更少，这些病例达到血糖控制所需时间为12.4±4.9天（范围5 - 24天）。在格列本脲治疗未达到血糖控制的女性中，26/31转换为胰岛素治疗，其中只有12例（46%）达到了理想的血糖控制水平。
大多数GDM女性在格列本脲治疗下达到了理想的血糖控制水平。
