Ignite Creation Date:
2024-05-05 @ 11:53 AM
Last Modification Date:
2024-10-26 @ 9:15 AM
Study NCT ID:
NCT00160485
Status:
WITHDRAWN
Last Update Posted:
2014-02-11
First Post:
2005-09-08
Brief Title:
Glyburide Compared to Insulin in the Management of Whites Classification A2 Gestational Diabetes
Sponsor:
Tripler Army Medical Center
Organization:
Tripler Army Medical Center
Study Overview
Official Title:
Glyburide Compared to Insulin in the Management of Whites Classification A2 Gestational Diabetes
Status:
WITHDRAWN
Status Verified Date:
2011-07
Last Known Status:
None
Delayed Posting:
No
If Stopped, Why?:
Active Duty principle investigator currently deployed
Has Expanded Access:
False
If Expanded Access, NCT#:
N/A
Has Expanded Access, NCT# Status:
N/A
Acronym:
None
Brief Summary:
The purpose of this study is to determine whether the oral administration of glyburide is as effective as insulin in the treatment of gestational diabetes
1 SYNOPSIS Infants born to mothers with gestational diabetesGDM are at risk for a variety of adverse perinatal outcomes including macrosomia with subsequent birth trauma and cesarean delivery neonatal hypoglycemia polycythemia jaundice hypocalcemia respiratory depression and newborn intensive care unit admission These adverse outcomes are thought to be related to the degree of maternal hyperglycemia during pregnancy Women with GDM are typically treated with insulin to lower blood glucose levels to as near-normal as possible A single randomized trial has suggested that the oral sulfonylurea glyburide is a clinically effective and safe alternative to insulin therapy
2 Many obstetric care providers have adopted the use of glyburide in the routine management of gestational diabetes The American College of Obstetrics and Gynecology and the American Diabetic Association both state that further studies are needed in a larger patient population before the use of newer oral hypoglycemic agents can be supported for use in pregnancy
3 STATUS Previous studies have demonstrated that there is no maternal-fetal transfer of glyburide and when compared to insulin is an effective alternative to insulin Additionally a published cost analysis concluded that glyburide is significantly less costly than insulin for the treatment of GDM The benefits of an oral agent for the management of gestational diabetes include less discomfort for the patient in drug administration lower requirement for patient education in the administration of injectable medications and less chance of error in dosing Our study population is more ethnically diverse and our incidence of large for gestational age infants is lower than in the largely Hispanic population studied by Langer et al Many obstetricians including ourselves apply different criteria than Langer for diagnosing gestational diabetes and for deciding when to institute insulin therapy It is our goal to confirm the prior single study concerning the safety and efficacy of glyburide in reducing the complications of GDM utilizing a more ethnically diverse population with more realistic goals in glycemic control To this end we will add to the medical literature supporting this alternative therapy to insulin
1 SYNOPSIS Infants born to mothers with gestational diabetesGDM are at risk for a variety of adverse perinatal outcomes including macrosomia with subsequent birth trauma and cesarean delivery neonatal hypoglycemia polycythemia jaundice hypocalcemia respiratory depression and newborn intensive care unit admission These adverse outcomes are thought to be related to the degree of maternal hyperglycemia during pregnancy Women with GDM are typically treated with insulin to lower blood glucose levels to as near-normal as possible A single randomized trial has suggested that the oral sulfonylurea glyburide is a clinically effective and safe alternative to insulin therapy
2 Many obstetric care providers have adopted the use of glyburide in the routine management of gestational diabetes The American College of Obstetrics and Gynecology and the American Diabetic Association both state that further studies are needed in a larger patient population before the use of newer oral hypoglycemic agents can be supported for use in pregnancy
3 STATUS Previous studies have demonstrated that there is no maternal-fetal transfer of glyburide and when compared to insulin is an effective alternative to insulin Additionally a published cost analysis concluded that glyburide is significantly less costly than insulin for the treatment of GDM The benefits of an oral agent for the management of gestational diabetes include less discomfort for the patient in drug administration lower requirement for patient education in the administration of injectable medications and less chance of error in dosing Our study population is more ethnically diverse and our incidence of large for gestational age infants is lower than in the largely Hispanic population studied by Langer et al Many obstetricians including ourselves apply different criteria than Langer for diagnosing gestational diabetes and for deciding when to institute insulin therapy It is our goal to confirm the prior single study concerning the safety and efficacy of glyburide in reducing the complications of GDM utilizing a more ethnically diverse population with more realistic goals in glycemic control To this end we will add to the medical literature supporting this alternative therapy to insulin
Detailed Description:
PLAN Women who present for prenatal care are routinely screened for gestational diabetes GDM with a one-hour 50gm oral glucose challenge test GCT This screening occurs at the first prenatal visit if risk factors marked obesity prior pregnancy affected by GDM prior macrosomic infant glycosuria strong family history of diabetes for GDM are identified on intake history If no risk factors for GDM are identified or if initial screening is negative the GCT is administered between 24-28 weeks gestation At our institution the GCT is considered positive if one hour after ingestion of a 50gm oral glucose solution the serum glucose is greater than or equal to 135mgdl This screening cutoff varies among medical treatment facilities Positive screening tests are followed by a diagnostic oral glucose tolerance test GTT A positive diagnosis requires that two or more thresholds be met or exceeded Women with the diagnosis of gestational diabetes will receive dietary counseling and instruction on the performing capillary glucose from a by a nurse educator If 20 of recorded home glucose values are in excess of target range following initiation of appropriate diet women will be offered enrollment into the study
All women who agree to participate in the study will have an ultrasound performed to confirm gestational age and rule out fetal anomalies a serum glycosylated hemoglobin A1C to assist in excluding preexisting diabetes and a fasting insulin level to assist in determining degree of insulin resistance A serum glycosylated hemoglobin A1C will be repeated upon admission for delivery Subjects randomized into standard therapy insulin arm will have their insulin dose calculated by established standards Dosing is based upon a 2 shot combined dose with long acting and short acting insulin given prior to breakfast and dinner If the fasting glucose values remain elevated the dinner NPH will be moved to bedtime Subcutaneous administration is recommended in a consistent anatomic region preferably the abdomen
Insulin will be adjusted on a weekly basis in order to maintain optimal glucose control Women assigned to receive glyburide will begin with 25mg orally with the morning meal Glyburide dosage will be increased weekly as indicated to a maximum daily dose of 20mg to achieve glucose control If the patient continues to have elevated fasting glucose the may be split to 12 hr intervals If maximum daily dose of glyburide does not result in reaching the threshold values patients will be administered insulin however data will be analyzed on an intent-to-treat basis
Upon admission for delivery additional maternal blood will be collected for hemoglobin A1C and glyburide levels These values will be utilized to determine efficacy of treatment and for comparison to fetal umbilical cord values
At delivery fetal blood from the umbilical cord will be collected for glucose hematocrit insulin level and in a representative sample glyburide level These values will be utilized to determine whether insulin or glyburide provides superior efficacy in maintaining these values within normal limits Cord blood glyburide levels will be obtained in a representative sample of exposed subjects
When clinically indicated labs are performed by the pediatrician on the newborn such as heel stick glucose for hypoglycemia bilirubin levels for neonatal jaundice calcium levels for suspected hypocalcemia these values will be obtained by review of the newborn record
In all gestational diabetics post partum assessment of diabetic status will be assessed with either a fasting glucose determination or a 2hr glucose tolerance test
All women who agree to participate in the study will have an ultrasound performed to confirm gestational age and rule out fetal anomalies a serum glycosylated hemoglobin A1C to assist in excluding preexisting diabetes and a fasting insulin level to assist in determining degree of insulin resistance A serum glycosylated hemoglobin A1C will be repeated upon admission for delivery Subjects randomized into standard therapy insulin arm will have their insulin dose calculated by established standards Dosing is based upon a 2 shot combined dose with long acting and short acting insulin given prior to breakfast and dinner If the fasting glucose values remain elevated the dinner NPH will be moved to bedtime Subcutaneous administration is recommended in a consistent anatomic region preferably the abdomen
Insulin will be adjusted on a weekly basis in order to maintain optimal glucose control Women assigned to receive glyburide will begin with 25mg orally with the morning meal Glyburide dosage will be increased weekly as indicated to a maximum daily dose of 20mg to achieve glucose control If the patient continues to have elevated fasting glucose the may be split to 12 hr intervals If maximum daily dose of glyburide does not result in reaching the threshold values patients will be administered insulin however data will be analyzed on an intent-to-treat basis
Upon admission for delivery additional maternal blood will be collected for hemoglobin A1C and glyburide levels These values will be utilized to determine efficacy of treatment and for comparison to fetal umbilical cord values
At delivery fetal blood from the umbilical cord will be collected for glucose hematocrit insulin level and in a representative sample glyburide level These values will be utilized to determine whether insulin or glyburide provides superior efficacy in maintaining these values within normal limits Cord blood glyburide levels will be obtained in a representative sample of exposed subjects
When clinically indicated labs are performed by the pediatrician on the newborn such as heel stick glucose for hypoglycemia bilirubin levels for neonatal jaundice calcium levels for suspected hypocalcemia these values will be obtained by review of the newborn record
In all gestational diabetics post partum assessment of diabetic status will be assessed with either a fasting glucose determination or a 2hr glucose tolerance test
Study Oversight
Has Oversight DMC:
None
Is a FDA Regulated Drug?:
None
Is a FDA Regulated Device?:
None
Is an Unapproved Device?:
None
Is a PPSD?:
None
Is a US Export?:
None
Is an FDA AA801 Violation?:
None