Metformin should be considered in the treatment of gestational diabetes: a prospective randomised study

Abstract

Objective To examine if oral metformin is as effective as insulin in the prevention of fetal macrosomy in pregnancies complicated with gestational diabetes mellitus (GDM).Design Open-label prospective randomised controlled study.Setting Maternity outpatient clinics in a secondary and tertiary level hospital in Finland.Sample One hundred women with GDM who did not attain euglycaemia with diet.Methods Women were randomised to therapy with insulin (n = 50) or oral metformin (n = 50).Main outcome measures Incidence of large-for-gestational-age (LGA) infants and neonatal morbidity.Results There were no statistically significant differences in the incidence of LGA (8.5 versus 10.0%, P = 0.97), mean birthweight, mean cord artery pH or neonatal morbidity between the insulin and metformin groups. Fifteen (31.9%) of the 47 women randomised to metformin needed supplemental insulin. They were more obese (with a body mass index of 36 versus 30 kg/m 2 , P = 0.002), had higher fasting blood glucose levels in an oral glucose tolerance test (6.1 versus 5.0 mmol/l, P = 0.001) and needed medical treatment for GDM earlier (26 versus 31 gestational weeks, P = 0.002) than women who were normoglycemic with metformin. There was a tendency to a higher rate of caesarean sections in the metformin group than in the insulin group (RR 1.9; 95% CI 0.99-3.71).Conclusions Metformin seems to be suitable for the prevention of fetal macrosomy, especially in lean or moderately overweight women developing GDM in late gestation. Women with considerable obesity, high fasting blood glucose and an early need for pharmacological treatment may be more suitable for insulin therapy.

Treatment of Gestational Diabetes Mellitus: Insulin or Metformin?

“…In this study, the patients needing additional insulin did not differ significantly with respect to age, parity, their OGTT, or HBA1c values. Study showed no association between BMI, glucose values in OGTT, and a need for additional insulin contrary to the findings of Ijas et al (32) The reason for this different result maybe chance, but the number of subjects in the study by Ijas et al (32) was greater than that in the present study.…”

“…In present study, there was no significant difference in occurrences of neonatal hypoglycaemia and preterm births between metformin and insulin groups. In fact, there were more preterm births in the insulin group than in the metformin group in the study of Mesdaghinia et al (36) There was no difference in incidence of preterm births between the groups in other studies (32,34,35) nor in this study. The risk of Respiratory Distress Syndrome (RDS) was low in this study and was not increased by the use of metformin according to previous studies.…”

“…Comparison of the results of study with those from previous randomised trials sets limitations; because cut off values used for medical treatment, target glucose values during medication and population ethnicity between the studies vary. Ijas et al (32) reported more assisted vaginal deliveries and intra-labour caesarean sections for prolonged labour in the metformin group than the insulin group. In other randomised trials as also in present study, there were no differences in the mode of delivery.…”

“…In this study, 25% of GDM patients in the metformin group needed additional insulin compared to 14-46% in previous randomised trials comparing metformin with insulin in GDM patients. (31)(32)(33)(34)(35) In the study of Moore et al (33) none of the metformin-treated patients needed additional insulin. The varying results in different studies with respect to the need for additional insulin maybe explained first by different glucose inclusion criteria in the OGTT and second by different fasting and postprandial glucose treatment targets.…”

Efficacy and safety of metformin for the treatment of gestational diabetes: a new approach to the problem

“…После исследования MIG было опубликовано мно-жество РКИ, посвященных сравнению метформина с инсулином, которые в большинстве своем подтвердили данные MIG [16][17][18][19][20][21][22][23]. Единственным ключевым отли-чием стало отсутствие тенденции к преждевременному родоразрешению в группе пациенток на метформине, которое было показано в MIG.…”