ObjectiveTo assess the efficacy and safety of treating pregnant women with gestational diabetes mellitus in comparison to usual antenatal care.MethodsA systematic review and meta-analysis was conducted by including randomized controlled trials comparing any form of therapeutic intervention in comparison to usual antenatal care. A literature search was conducted using electronic databases together with a hand search of relevant journals and conference proceedings.ResultsTen studies involving 3,881 patients contributed to meta-analysis. Our results indicated that gestational diabetes mellitus treatment significantly reduced the risk for macrosomia (RR, 0.47; 95% CI, 0.38–0.57), large for gestational age births (RR, 0.55; 95% CI, 0.45–0.67), shoulder dystocia (RR, 0.42; 95% CI, 0.23–0.77) and gestational hypertension (RR, 0.68; 95% CI, 0.53–0.87) without causing any significant increase in the risk for small for gestational age babies. However, no significant difference was observed between the two groups regarding perinatal/neonatal mortality, neonatal hypoglycemia, birth trauma, preterm births, pre-eclampsia, caesarean section and labor induction.ConclusionTreating GDM reduces risk for many important adverse pregnancy outcomes and its association with any harm seems unlikely.

ObjectiveTo assess the efficacy and safety of oral antidiabetic drugs (OADs) in gestational diabetes mellitus (GDM) in comparison to insulin.MethodsA meta-analysis of randomized controlled trials was conducted. The efficacy and safety of OADs in comparison to insulin in GDM patients were explored. Studies were identified by conducting a literature search using the electronic databases of Medline, CENTRAL, CINAHL, LILACS, Scopus and Web of Science in addition to conducting hand search of relevant journals from inception until October 2013.ResultsThirteen studies involving 2,151 patients met the inclusion criteria. These studies were randomized controlled trials of metformin and glyburide in comparison to insulin therapy. Our results indicated a significant increase in the risk for preterm births (RR, 1.51; 95% CI, 1.04–2.19, p = 0.03) with metformin compared to insulin. However, a significant decrease in the risk for gestational hypertension (RR, 0.54; 95% CI, 0.31–0.91, p = 0.02) was found. Postprandial glucose levels also decreased significantly in patients receiving metformin (MD, −2.47 mg/dL; 95% CI, −4.00, −0.94, p = 0.002). There was no significant difference between the two groups for the remaining outcomes. There were significant increases in the risks of macrosomia (RR, 2.34; 95% CI, 1.18–4.63, p = 0.03) and neonatal hypoglycemia (RR, 2.06; 95% CI, 1.27–3.34, p = 0.005) in the glyburide group compared to insulin whereas results for the other analyzed outcomes remained non-significant.ConclusionThe available evidence suggests favorable effects of metformin in treating GDM patients. Metformin seems to be an efficacious alternative to insulin and a better choice than glyburide especially those with mild form of disease.

The incidence of type 2 diabetes mellitus is increasing rapidly, as are the associated co-morbidities. Consequently, it has become necessary for a diabetic patient to take multiple medications at the same time to delay progression of the disease. This can put patients at an increased risk of moderate to severe drug interactions, which may threaten patients' life or may deteriorate the quality of their life. Hence, managing drug-drug interactions is the cornerstone of anti-diabetic therapy. Most of the clinically important drug-drug interactions of anti-diabetic agents are related to their metabolic pathways, but drugs that compete for renal excretion or impair renal status can also play an important role. In this review, we have examined the clinical implications and underlying mechanisms of drugs that are likely to alter the pharmacologic response of or cause adverse events with antidiabetic drugs, and we have outlined safe and efficacious treatment modalities.

Organochlorine pesticides (OCPs) are frequently used worldwide as insecticides, fungicides, herbicides and termiticides and have been associated with a variety of cancers in animal and human studies. In the present study, we examined residues of fourteen OCPs in the serum samples of diagnosed cancer patients and healthy residents of Karachi, Pakistan. A random collection of fasting blood samples was carried out from the donors with informed consent. Serum was separated within 2 h of blood collection and was then subjected to extraction with organic solvents followed by purification with florisil column. The final organic extract of each serum sample was processed with Gas Chromatograph coupled with Electron Capture Detector (GC-ECD). OCPs were detected in 97.59% of the cancer cases and 93.75% of the healthy subjects. Mean concentrations of total OCPs (ΣOCPs) was found elevated in the cancer group (0.606 mg/kg) compared with the control group (0.322 mg/kg). Endosulfan was the highest prevalent OCP with a mean concentration of 0.214 mg/kg in the cancer group and 0.166 mg/kg in the control group. The second most prevalent OCP was 4,4-DDE with a mean concentration of 0.131 mg/kg in the cancer group and 0.019 mg/kg in the control group. Highest level of ΣOCPs was detected in the breast cancer cases (20.411 mg/kg) with a mean level of (2.041 mg/kg). In light of the obtained results and available literature on the subject, it has been concluded that OCPs are positively associated with the risk of various cancers in humans.

Metformin seems to be a superior choice to glyburide if oral antidiabetic drug therapy is to be initiated in GDM patients.