It was a great pleasure to review the paper entitled "Glyburide therapy for gestational

diabetes: Glycaemic control, maternal hypoglycaemia, and treatment failure" by

Helene Affres et al.1 We were fortunate to read this article, which was informative
and constructive.

However, we recognize the limitations indicated in the study, but there are different
approaches that can be applied to improve the study outcome. Perhaps the authors
misinterpreted the exclusion criteria because in their study they did not mention the
exclusion of participants with comorbids.

For example, a study conducted in 2018 excluded participants with diabetes, pre-
eclampsia, chronic hypertension and liver disease, as they have a great influence on
blood sugar levels.2 In addition, the authors should have considered the large
sample size, given that the small sample size may affect the conclusion of the study.
For example, one study conducted in 2012 chose to consider 10,682 studies that
reinforced their study and supported their findings. 3 

Thirdly, the authors, in addition to measuring blood glucose levels per glucometer,
should have taken into consideration the measurement of glycosylated hemoglobin
and serum peptide C. As an illustration, a study carried out in 2000 measured
glucose levels using a glucose meter and was again tested in a laboratory once a
week during a clinic visit to increase the effectiveness of test results. 4 Finally, taking
into account multivariate logistic regression to determine predicted failure factors for
glyburide would add value to the results of study.5

 
References:

1. Affres H, Senat MV, Letourneau A, Deruelle P, Coustols-Valat M, Bouchghoul

H, Bouyer J. Glyburide therapy for gestational diabetes: Glycaemic control,
maternal hypoglycaemia, and treatment failure. Diabetes Metab. 2021
Jul;47(4):101210. doi: 10.1016/j.diabet.2020.11.002. Epub 2020 Nov 26. PMID:
33249198.
2. Sénat MV, Affres H, Letourneau A, Coustols-Valat M, Cazaubiel M, Legardeur
H, Jacquier JF, Bourcigaux N, Simon E, Rod A, Héron I, Castera V, Sentilhes L,
Bretelle F, Rolland C, Morin M, Deruelle P, De Carne C, Maillot F, Beucher G,
Verspyck E, Desbriere R, Laboureau S, Mitanchez D, Bouyer J; Groupe de
Recherche en Obstétrique et Gynécologie (GROG). Effect of Glyburide vs
Subcutaneous Insulin on Perinatal Complications Among Women With
Gestational Diabetes: A Randomized Clinical Trial. JAMA. 2018 May
1;319(17):1773-1780. doi: 10.1001/jama.2018.4072. PMID: 29715355; PMCID:
PMC6583037.
3. Cheng YW, Chung JH, Block-Kurbisch I, Inturrisi M, Caughey AB. Treatment of
gestational diabetes mellitus: glyburide compared to subcutaneous insulin
therapy and associated perinatal outcomes. J Matern Fetal Neonatal Med.
2012 Apr;25(4):379-84. doi: 10.3109/14767058.2011.580402. Epub 2011 Jun 1.
PMID: 21631239; PMCID: PMC3443974.
4. Langer O, Conway DL, Berkus MD, Xenakis EM, Gonzales O. A comparison of
glyburide and insulin in women with gestational diabetes mellitus. N Engl J
Med. 2000 Oct 19;343(16):1134-8. doi: 10.1056/NEJM200010193431601.
PMID: 11036118.
5. Yogev Y, Melamed N, Chen R, Nassie D, Pardo J, Hod M. Glyburide in
gestational diabetes--prediction of treatment failure. J Matern Fetal Neonatal
Med. 2011 Jun;24(6):842-6. doi: 10.3109/14767058.2010.531323. Epub 2010
Nov 10. PMID: 21067291.