Could Metformin Manage Gestational Diabetes Mellitus instead of Insulin?

Abstract

Gestational diabetes mellitus (GDM) complicates a significant number of pregnancies. Blood glucose control improves perinatal outcomes. Medical nutrition therapy is the foundation in management. Aim of This Study. To evaluate efficacy of metformin in comparison to insulin for managing GDM. Methods. In prospective randomized comparative study, 150 antenatal women whose pregnancies had been complicated by GDM and did not respond to diet alone were recruited from antenatal clinics at Obstetrics Department in Zagazig University Hospitals from November 2012 to December 2014. They were divided randomly into two groups, 75 patients in each, and were subjected to either insulin or metformin medication. Outcomes were comparing the effects of both medications on maternal glycemic control, antenatal complications, and neonatal outcome. Results. No significant difference in controlling high blood sugar in GDM with the use of metformin or insulin (P = 0.95, 0.15). Maternal complications in both groups had no significant difference and fetal outcomes were as well similar except the fact that the hypoglycemia occurred more in insulin group with P value 0.01. Conclusion. Glycaemic control in GDM can be achieved by using metformin orally without increasing risk of maternal hypoglycemia with satisfying neonatal outcome.

Metformin for prevention of hypertensive disorders of pregnancy in women with gestational diabetes or obesity: systematic review and meta‐analysis of randomized trials

“…The participants' characteristics varied among the studies, which included women with GDM (13 studies) or obese women (two studies). Metformin was compared with insulin (eight studies), placebo (two studies) or glyburide (five studies) 10,[26][27][28][29][30][31][32][33][34][35][36][37][38][39] . Mean gestational age at randomization and the risk characteristics differed greatly among the studies (Table 1).…”

“…BMI, body mass index; GA, gestational age; GDM, gestational diabetes mellitus; NR, not reported. 31 15 (31.9) 750-2250 NR NR Moore (2010) 27 26 (34.7) 500-2000 NR NR Nachum (2017) 26 9 (17) 850-2250 NR NR Najafian (2017) 38 NR 500-2000 NR 26% of patients were on 2000 mg, 66% were on 1500 mg, 5.9% were on 1000 mg and 1% were on 500 mg Niromanesh (2012) 32 11 (13.8) 1000-2500 NR Median, 1500 mg (IQR: 1000-2500 mg) Pujara (2017) 37 13 (26.0) 500-2500 NR NR Rowan (2008) 33 168 (46.3) 500-2500 69.4% All but one participant received more than 1000 mg, with median dose of 2500 mg Saleh (2016) 39 NR 500-3000 NR NR Silva (2010) 34 8 (25.0) 500-2500 NR Mean ± SD, 1284 ± 535 mg Spaulonci (2013) 35 12 ( First author only is given for each study. *Reported as per individual study protocol.…”

“…We used both random-and fixed-effects models for studies comparing metformin with placebo, which yielded conflicting results. The studies included in this analysis were quite similar in their design and execution, and thus were characterized by low clinical Moore (2010) 27 Nachum (2017) 26 Pujara (2017) 37 Silva (2010) 34 Ainuddin (2014) 28 Ijas (2011) 31 Najafian (2017) 38 Niromanesh (2012) 32 Rowan (2008) 33 Saleh (2016) 39 Spaulonci (2013) 35 Tertti (2013) 36 Chiswick (2015) 29 Syngelaki (2016) Silva (2010) 34 Ainuddin (2014) 28 Niromanesh (2012) 32 Rowan (2008) 33 Tertti (2013) 36 Chiswick (2015) 29 Syngelaki (2016) 10 Summary estimate Moore (2010) 27 Ainuddin (2014) 28 Ijas (2011) 31 Najafian (2017) 38 Niromanesh (2012) 32 Rowan (2008) 33 Saleh (2016) 39 Spaulonci (2013) 35 Tertti (2013) 36 Chiswick (2015) 29 Syngelaki (2016) heterogeneity but high statistical heterogeneity. However, it is unlikely that the summary estimates presented by either method are good representations of the real effect.…”

Very tight vs. tight control: what should be the criteria for pharmacologic therapy dose adjustment in diabetes in pregnancy? Evidence from randomized controlled trials

“…We identified 51 RCTs on therapy for GDM or pregestational diabetes, and assessed these for eligibility (Figure ) . Of them, 34 were excluded, and therefore 17 including 4230 women were included .…”

“…Carbohydrate disorders in pregnancy, including gestational diabetes mellitus (GMD) and pregestational diabetes mellitus (DM), are the most common morbidities complicating pregnancy, with short‐ and long‐term consequences to mothers, fetuses, and newborns. It has been estimated that up to 6–7% or more of all pregnancies are complicated by DM in pregnancy . The latest reports from the International Diabetes Federation estimate that, worldwide, approximately one in seven births in 2015 were complicated by some form of hyperglycemia during pregnancy .…”