Factors Associated with the Need for Insulin as a Complementary Treatment to Metformin in Gestational Diabetes Mellitus

Abstract

Objective To evaluate the factors associated with the need for insulin as a complementary treatment to metformin in pregnant women with gestational diabetes mellitus (GDM). Methods A case-control study was performed from April 2011 to February 2016 with pregnant women with GDM who needed complementary treatments besides diet and physical exercise. Those treated with metformin were compared with those who, in addition to metformin, also needed the combination with insulin. Maternal characteristics and glycemic control were evaluated. Multinomial logistic regression models were developed to evaluate the influence of different therapies on neonatal outcomes. Results A total of 475 pregnant women who needed pharmacological therapy were evaluated. Of these, 366 (77.05%) were submitted to single therapy with metformin, and 109 (22.94%) needed insulin as a complementary treatment. In the analysis of the odds ratio (OR), fasting glucose (FG) < 90 mg/dL reduced the odds of needing the combination (OR: 0.438 [0.235–0.815]; p = 0.009], as well as primiparity (OR: 0.280 [0.111–0.704]; p = 0.007]. In obese pregnant women, an increased chance of needing the combination was observed (OR: 2,072 [1,063–4,039]; p = 0,032). Conclusion Obesity resulted in an increased chance of the mother needing insulin as a complementary treatment to metformin, while FG < 90 mg/dL and primiparity were protective factors.

Predictors of metformin monotherapy failure in gestational diabetes mellitus

“…The metformin monotherapy failure rate we found was similar to other published studies, with values ranged from 18 to 23% ( 11 , 22 , 23 , 24 ). However, some groups described even higher rates, such as Moore et al .…”

“…It is hypothesized in the literature that the notorious association between maternal pregestational overweight or obesity and the worse efficacy of metformin monotherapy in GDM treatment may be due to greater insulin resistance and/or impaired beta cell function ( 22 , 27 ). Also, we verified that a higher pregestational BMI was significantly more frequent in the group that needed insulin, 51.3% of these women being obese.…”

Impact Of Prepregnancy Overweight And Obesity On Treatment Modality And Pregnancy Outcome In Women With Gestational Diabetes Mellitus

“…Other studies ( 26 , 27 ) reported lower rates of metformin treatment failure. Previous research, aiming to assess the contributors to the observed failure rate of metformin monotherapy in pregnant women, concluded that the chance for responding to metformin was lower in patients with increased BMI ( 17 , 28 , 29 ) and higher fasting glucose levels ( 26 , 28 , 29 ). It is also noteworthy that large intervention studies failed to identify a protective effect of metformin on the risk of GDM, further suggesting that metformin is less effective in mothers with obesity ( 30 , 31 ).…”

Incidência de obesidade em gestantes diabéticas com ou sem o uso de terapêutica medicamentosa

“…Esse tipo de tratamento pode ser realizado com o uso de hipoglicemiantes orais e/ou da insulinoterapia. Acreditase que de 15% a 60% das pacientes necessitem do uso da farmacologia em conjunto com a mudança de hábitos para que haja o controle da doença (Souza et al, 2019;Lende;Rijhsinghani, 2020;Zheng et al, 2017;Di Biase et al, 2019;Koning et al, 2016).…”

“…Os análogos de insulina asparte e lispro têm vantagens sobre a insulina regular, promovendo melhor controle dos níveis de glicemia pós-prandiais com menor ocorrência de hipoglicemias. Acredita-se que de 15% a 60% das pacientes necessitem do uso da farmacologia em conjunto com a mudança de hábitos para que haja o controle da doença (Souza et al, 2019).…”