Glycemic Control and Neonatal Outcomes in Women With Gestational Diabetes Mellitus Treated Using Glyburide, Metformin, or Insulin: A Pairwise and Network Meta-Analysis

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Aims: We aimed to assess the comparative efficiency and safety of the use of glyburide, metformin, and insulin in gestational diabetes mellitus (GDM).Methods: We searched for randomized controlled trials that compared glyburide, metformin, and insulin in GDM. Data regarding glycemic control and neonatal safety were collected and analyzed in pairwise and network meta-analyses.Results: A total of 4,683 individuals from 24 trials were included. Compared with glyburide, metformin reduced 2-hour postprandial blood glucose (2HPG) to a greater extent (standard mean difference (SMD) 0.18; 95% credible interval (CI) 0–0.36). There were significantly lower prevalences of neonatal hypoglycemia (risk difference (RD) −0.07; 95%CI−0.11–−0.03), neonatal intensive care unit (NICU) admission (RD−0.03; 95%CI−0.06–−0), and preeclampsia (RD−0.03; 95%CI−0.06–−0) in the metformin group than in the insulin group. The metformin group had significantly lower birth weight (SMD−0.25; 95%CI−0.41–−0.10) and maternal weight gain (SMD−0.61; 95%CI−0.86–−0.35) compared with the insulin group. Network meta-analysis suggested that metformin had the highest probability of successfully controlling glycemia and preventing neonatal complications.Conclusions: The present meta-analysis suggests that metformin may be as effective as insulin for glycemic control and is the most promising drug for the prevention of neonatal and maternal complications.