Metformin as a Safe Option to Insulin in Gestational Diabetes Mellitus: a Retrospective Study

Abstract

When pharmacological treatment is needed to reach control of gestational diabetes mellitus (GDM), insulin is still first-line agent but metformin has been progressively pointed as an effective alternative. Our aim is to confirm whether metformin is an effective and safe option to insulin, by comparing maternal and foetal outcomes between women with GDM treated with these drugs. Retrospective study including 399 women with GDM, 135 needing pharmacological treatment. Comparison of demographic features, risk factors for GDM, maternal and foetal outcomes between women treated with insulin (G1, 41/135) and those treated with metformin (G2, 94/135). X 2 /Fisher tests were performed. Significance was set at p < 0.05. Both groups showed similar features and risk factors for GDM, except for chronic hypertension, more prevalent in G1. Therapy with insulin showed poorer metabolic control with higher rate of pregnant with HbA1c ≥ 6% (42 mmol/mol) (25.6 vs 4.5%, p = 0.001) and more polihydramnios (14.6% vs 3.2%, p = 0.023). A higher rate of caesarean was observed in G1, however, with no statistical difference (42.5% vs 26.9%, p = 0.076). There were more newborns weighing < 2500 g in women treated with metformin. No other outcome showed difference with statistical significance, namely maternal weight gain, macrosomia or neonatal comorbidities. Metformin allowed a good metabolic control with maternal and foetal outcomes similar to insulin. Metformin has proven effective as a pharmacological option to insulin. Prospective and randomized studies are needed as well as evaluation of long term benefits of metformin.

Insulin Use During Gestational and Pre-existing Diabetes in Pregnancy: A Systematic Review of Study Design

“…Among women diagnosed with GDM, across different interventions, retrospective analyses revealed that cases of cesarean section and preterm delivery were higher in women managed with insulin than in those managed with other interventions such as diet/MNT, metformin and metformin + insulin [ 28 , 32 , 45 , 46 ]. Compared with other interventions, insulin did not show a significant difference in the rate of gestational hypertension and induced labor in women treated with insulin and those managed with lifestyle modification [ 47 , 48 ] or metformin [ 49 , 50 ]. In the mixed population, a prospective cohort study by Negrato et al compared insulin glargine with NPH and reported a significantly higher rate of preeclampsia in the NPH-treated group compared to the glargine-treated group ( p < 0.0001) in women diagnosed with diabetes prior to pregnancy [ 51 ].…”

Performance Evaluation of Naive Bayes and Back Propagation Neural Network classifiers in gestational Diabetes Mellitus Classification

“…A lattice neural network framework equipped by the Levenberg-Marquardt (LM) methodology and a deterministic neural network framework detects the diabetic condition by careful analysis of the insulin results [6].On the Canadian community, an efficient statistical model with high precision and specificity is built and tested and is more accurate and effective to adapt to Canadian clinicians than current models produced from US or other societies. The most powerful determinants in these simulations were fasted blood sugar, human body mass index, high degree of density lipoprotein and cholesterol [7].The planned research develops on early diagnosis of GDM for mother who is second time pregnant without a referral to clinic. The need of Artificial Neural Network technologies for disease prediction is showing improved efficiency in ethical decision-making.…”