Predicting failure of glyburide therapy in gestational diabetes

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.