Efficacy and Safety of Oral Insulin Analogs

Oral Insulin Analogs and Gestational Diabetes

Efficacy and Safety of Oral Insulin Analogs during Pregnancy

The promise of better glycemic control and patient treatment compliance is offered by oral insulin analogs (Lee-Parritz, 2012). In the United States and Europe, the most common insulin analogs used to treat pregnant women are the sulphonylureas glyburide and glibenclamide, and the biguanide metformin (Nicholson and Baptiste-Roberts, 2011). Most studies examining the efficacy and safety of insulin analogs have relied on gestational diabetes patients, therefore there has been little data generated using type II pregestational diabetes patients. However, Lee-Parritz (2012) assumes the successful use of these drugs in patients with gestational diabetes should not deter physicians from turning to these drugs when treating pregestational diabetes.

A recent meta-analysis of six randomized, controlled studies, having a combined subject pool of 1388 patients, compared insulin to oral insulin analogs (glyburide and metformin) in terms of infant and maternal health outcomes (Dhulkotia, Ola, Fraser, and Farrell, 2010). Overall, maternal glycemic control, infant hypoglycemia, macrosomia, or caesarean deliveries were not significantly different between insulin and the insulin analogs. When these results are combined with reports that oral analogs in common use do not cross the placental barrier at significant levels to cause harm (Lee-Parritz, 2012), these insulin analogs appear to be safe and effective. Although metformin in some patients may require insulin supplementation, the evidence to date suggests that these analogs may provide glycemic control and pregnancy outcomes equal to insulin. In light of the potential for better patient compliance and the tendency of insulin to trigger postprandial hypoglycemia, these drugs appear to represent viable alternatives to insulin.

References

Dhulkotia, Jaya Saxena, Ola, Bolarinde, Fraser, Robert, and Farrell, Tom. (2010). Oral hypoglycemic agents vs. insulin in the management of gestational diabetes: A systematic review and meta-analysis. American Journal of Obstetrics & Gynecology, 203, 457.e1-457.e9.

Lee-Parritz, Aviva. (2012). New technologies for the management of pregestational diabetes mellitus. Obstetrical and Gynecological Survey, 67(3), 167-175.

Nicholson, Wanda and Baptiste-Roberts, Kesha. (2011). Oral hypoglycaemic agents during pregnancy: The evidence for effectiveness and safety. Best Practice & Research Clinical obstetrics and Gynaecology, 25, 51-63.