Predicting failure of glyburide therapy in gestational diabetes

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Abstract

OBJECTIVE:

We sought to develop a prediction model to identify women with gestational diabetes (GDM) who require insulin to achieve glycemic control.

STUDY DESIGN:

Retrospective cohort of all singletons with GDM treated with glyburide from 2007 to 2013. Glyburide failure was defined as reaching glyburide 20 mg day-1 and receiving insulin. Glyburide success was defined as any glyburide dose without insulin and >70% of visits with glycemic control. Multivariable logistic regression analysis was performed to create a prediction model.

RESULT:

Of the 360 women, 63 (17.5%) qualified as glyburide failure and 157 (43.6%) as glyburide success. The final prediction model for glyburide failure included prior GDM, GDM diagnosis ≤ 26 weeks, 1-h glucose challenge test ≥228 mg dl-1, 3-h glucose tolerance test 1-h value ≥ 221 mg dl-1, ≥ 7 postprandial blood sugars >120 mg dl-1 in the week glyburide started and ≥ 1 blood sugar >200 mg dl-1. The model accurately classified 81% of subjects.

CONCLUSION:

Women with GDM who will require insulin can be identified at the initiation of pharmacological therapy.

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