Metformin for gestational diabetes study: metformin vs insulin in gestational diabetes: glycemic control and obstetrical and perinatal outcomes: randomized prospective trial

Picón-César, María José; Molina-Vega, María; Suárez-Arana, María; González-Mesa, Ernesto; Sola-Moyano, Ana P.; Roldan-López, Reyes; Romero-Narbona, Francisca; Olveira, Gabriel; Tinahones, Francisco J.; González-Romero, Stella

doi:10.1016/j.ajog.2021.04.229

Cited by 37 publications

(31 citation statements)

References 34 publications

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“… 2 , 7 , 27 , 32 – 38 The most recent evidence is from the 2021 Metformin for Gestational Diabetes Study (MeDiGes) conducted in 200 patients with GDM, which reinforces these findings showing less hypoglycaemia, better postprandial glycaemic values for lunch and dinner, less weight gain, fewer labour inductions, and fewer caesarean sections with metformin compared to insulin. 39 The MeDiGes trial found similar rates of mean birth weight, macrosomia, LGA infants and infant complications between both groups. 39 Some studies, including a large meta-analysis of over 4000 patients, have found higher rates of smaller-for-gestational-age neonates in patients receiving metformin versus insulin.…”

Section: Reviewmentioning

confidence: 96%

“… 39 The MeDiGes trial found similar rates of mean birth weight, macrosomia, LGA infants and infant complications between both groups. 39 Some studies, including a large meta-analysis of over 4000 patients, have found higher rates of smaller-for-gestational-age neonates in patients receiving metformin versus insulin. 36 When metformin is compared to glyburide, there is a decrease in the composite of neonatal death or serious morbidity.…”

Section: Reviewmentioning

confidence: 96%

“… 32 Other studies have seen failure rates that range from 21.3% to 85%. 6 , 39 , 46 Due to this high failure rate, it may be prudent to initiate a patient on insulin at the onset rather than delay achieving optimal glycaemic control with a trial of metformin. However, at least one small study has shown benefits for starting the patient on metformin and switching to insulin if needed compared to starting with insulin alone.…”

Section: Reviewmentioning

confidence: 99%

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Diabetes: how to manage gestational diabetes mellitus

Mukherjee¹,

Dawson²

2022

DIC

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Due to worldwide increases in obesity and average maternal age, the incidence of gestational diabetes mellitus (GDM) is increasing. The primary treatment of GDM is medical nutrition therapy but approximately 15–30% of individuals need pharmacotherapy to reach blood glucose goals to minimize the adverse consequences of hyperglycaemia. In the past, regular and neutral protamine Hagedorn insulin were the mainstays of pharmacological treatment for GDM due to their well-established safety; however, because they are administered as injections and require strict timing of doses and meals to minimize hypoglycaemia, alternatives are often sought. The research around the treatment of GDM continues to evolve as insulin analogues and oral agents are studied in clinical trials. The short-term and long-term effects of treatment choices on both mothers and progeny are being evaluated, and this narrative review summarizes the current state of information available regarding the treatment of GDM.

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Section: Reviewmentioning

confidence: 96%

Section: Reviewmentioning

confidence: 96%

Section: Reviewmentioning

confidence: 99%

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Diabetes: how to manage gestational diabetes mellitus

Mukherjee¹,

Dawson²

2022

DIC

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“…Recent research has highlighted the advantages of metformin over insulin in terms of perinatal outcomes and ease of care. Several studies have reported on the benefits of metformin on perinatal outcomes compared to insulin in terms of prevention of macrosomia, severe neonatal hypoglycaemia, 14 maternal hypoglycaemia, lower postprandial readings, 15,16 GWG, [14][15][16] pre-eclampsia and gestational hypertension 14 ; however, no differences were found in primary outcomes such as respiratory distress, hyperbilirubinaemia and birth trauma. 14,17 Furthermore, metformin also requires less monitoring in pregnancy and has patient preference over insulin, 14 even though a small portion of women may experience gastrointestinal side effects and up to 20-50% women may need some supplemental insulin.…”

mentioning

confidence: 99%

“…Another concern of clinicians when treating women with metformin is growth restriction or small for gestational age (SGA) infants. However, the risk of SGA babies was noted only in studies of women with type 2 diabetes exposed to metformin and not in women with polycystic ovary syndrome or GDM 15,20 or obese pregnant women. As a precautionary approach, the risk of growth restriction with metformin can be monitored through fetal growth surveillance.…”

mentioning

confidence: 99%

Metformin: A promising option for the management of gestational diabetes mellitus – Exploring the benefits, challenges and clinical needs in the current management of gestational diabetes mellitus

Bastian

Smithers

Davis

et al. 2022

Aust NZ J Obst Gynaeco

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The incidence of gestational diabetes mellitus (GDM) is increasing. One in three women require insulin to achieve glycaemic targets in GDM. However, it is unclear whether insulin therapy alone is the most effective treatment for all women in achieving glycaemic control and preventing adverse pregnancy outcomes. Although no oral hypoglycaemic agents are approved for pregnancy in Australia, recent research indicates that metformin is effective in preventing adverse perinatal outcomes and may even have possible benefits in the long term. Furthermore, there appears to be a specific role for both metformin and insulin among the GDM population. Metformin provides an option to offer an individualised approach to treat GDM.

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Glycemic Control Trajectories and Risk of Perinatal Complications Among Individuals With Gestational Diabetes

et al. 2022

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ImportanceGlycemic control is the cornerstone of gestational diabetes management. Glycemic control trajectories account for differences in longitudinal patterns throughout pregnancy; however, studies on glycemic control trajectories are scarce.ObjectiveTo examine whether glycemic control trajectories from gestational diabetes diagnosis to delivery were associated with differential risk of perinatal complications.Design, Setting, and ParticipantsThis population-based cohort study included individuals with gestational diabetes with longitudinal electronic health record data from preconception to delivery who received prenatal care at Kaiser Permanente Northern California (KPNC) and were enrolled in KPNC’s telemedicine-based gestational diabetes care program between January 2007 and December 2017. Data analysis was conducted from September 2021 to January 2022.ExposuresGlycemic control trajectories were derived using latent class modeling based on the American Diabetes Association’s recommended self-monitoring of blood glucose measurements. Optimal glycemic control was defined as at least 80% of all measurements meeting the targets at KPNC clinical settings.Main Outcomes and MeasuresMultivariable Poisson regression models were used to estimate the associations of glycemic control trajectories with cesarean delivery, preterm birth, shoulder dystocia, large- and small-for-gestational-age, and neonatal intensive care unit admission and stay of 7 days or longer.ResultsAmong a total of 26 774 individuals (mean [SD] age, 32.9 [5.0] years; 11 196 Asian or Pacific Islander individuals [41.8%], 1083 Black individuals [4.0%], 7500 Hispanic individuals [28.0%], and 6049 White individuals [22.6%]), 4 glycemic control trajectories were identified: stably optimal (10 528 individuals [39.3%]), rapidly improving to optimal (9151 individuals [34.2%]), slowly improving to near-optimal (4161 individuals [15.5%]), and slowly improving to suboptimal (2934 individuals [11.0%]). In multivariable models with the rapidly improving to optimal trajectory group as the reference group, glycemic control trajectories were associated with perinatal complications with a gradient across stably optimal to slowly improving to suboptimal. For individuals in the stably optimal trajectory group, there were lower risks of cesarean delivery (adjusted relative risk [aRR], 0.93 [95% CI, 0.89-0.96]), shoulder dystocia (aRR, 0.75 [95% CI, 0.61-0.92]), large-for-gestational age (aRR, 0.74 [95% CI, 0.69-0.80]), and neonatal intensive care unit admission (aRR, 0.90 [95% CI, 0.83-0.97]), while for patients in the slowly improving to suboptimal glycemic control trajectory group, risks were higher for cesarean delivery (aRR, 1.18 [95% CI, 1.12-1.24]; (P for trend &lt; .001), shoulder dystocia (aRR, 1.41 [95% CI, 1.12-1.78]; P for trend &lt; .001), large-for-gestational-age (aRR, 1.42 [95% CI, 1.31-1.53]; P for trend &lt; .001), and neonatal intensive care unit admission (aRR, 1.33 [95% CI, 1.20-1.47]; P for trend &lt; .001). The risk of small-for-gestational-age was higher in patients in the stably optimal group (aRR, 1.10 [95% CI, 1.02-1.20]) and lower in the slowly improving to suboptimal group (aRR, 0.63 [95% CI, 0.53-0.75]).Conclusions and RelevanceThese findings suggest that slowly improving to near-optimal and slowly improving to suboptimal glycemic control trajectories were associated with increased risk of perinatal complications. Future interventions should help individuals achieve glycemic control early after gestational diabetes diagnosis and throughout pregnancy to decrease the risk of perinatal complications.

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Metformin for gestational diabetes study: metformin vs insulin in gestational diabetes: glycemic control and obstetrical and perinatal outcomes: randomized prospective trial

Cited by 37 publications

References 34 publications

Diabetes: how to manage gestational diabetes mellitus

Diabetes: how to manage gestational diabetes mellitus

Metformin: A promising option for the management of gestational diabetes mellitus – Exploring the benefits, challenges and clinical needs in the current management of gestational diabetes mellitus

Glycemic Control Trajectories and Risk of Perinatal Complications Among Individuals With Gestational Diabetes

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