Metformin in the treatment of gestational diabetes mellitus: is it safe and efficient? (original) (raw)
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Metformin compared to insulin for the management of gestational diabetic
International Journal of Research in Pharmaceutical Sciences, 2018
A prospective comparative two arms study done in Al Kadhimiya teaching hospital for 1 year duration from June 2017 till June 2017, this study included 150 women with singleton pregnancies diagnosed with gestational DM. The primary endpoints were neonatal outcomes which include; neonatal hypoglycemia (≥2 neonatal glucose values 46.8 m/dL), respiratory distress (admission to neonatal care unite NUC), need for phototherapy (neonatal jaundice), 5-minute Apgar scores below 7, or premature birth (<37 weeks of gestation). The maternal outcome includes the rate of gestational hypertension, preeclampsia, mode of delivery and Polyhydramnios. Metformin offer less risk for the neonate to have an episode of blood glucose level <28.8 mg/dl compared to insulin RR (95%CI): 0.598 (0.457 – 0.999) and it was significant, metformin also offer less risk for the neonate to have recurrent blood glucose level <46.8 mg/dl RR (95%CI): 0.820 (0.586 – 1.289) but it was not statistically significant, m...
Assessment of Metformin Versus Insulin for the Treatment of Gestational Diabetes
The Medical Journal of Cairo University
Background: Metformin is a logical treatment for women with gestational diabetes, but randomized trials to assess the efficacy and safety of its use for this condition are lacking. Aim of Study: To compare the efficacy of oral metformin therapy versus insulin treatment in patients with gestational diabetes mellitus in term of Maternal glycemic control, Maternal outcome and Fetal outcome. Patients and Method: A total of 156 patients who have the diagnosis of gestationl diabetes were enrolled after fulfilling certain inclusion and exclusion criteria. They were randomly assigned to two groups of treatment with either insulin or metformin. Serial ultra-sound examination and blood glucose level were assessed at enrolment and at follow-up visits. The outcomes were fetal and maternal outcomes. Results: Of the 78 patients at each group 89.7% of patients using metformin were compliant to its use while only 39.7% who received insulin therapy were compliant to it (p-value 0.015), neonatal hypoglycemia was associated more with insulin group than metformin group (7.7% vs. 0.0%, p-value 0.028). The rates of other outcomes did not differ significantly between the groups. There were no serious adverse events associated with the use of metformin. Conclusion: Oral metformin therapy is an effective and safe treatment option for women with gestational diabetes who meet the criteria for starting insulin, and that metformin is more acceptable than insulin. But further follow-up data are needed to establish long-term safety regarding the pregnancy outcome.
International Journal of Reproduction Contraception Obstetrics and Gynecology, 2014
Background: Objectives of current study were to assess the efficacy of metformin in the management of Gestational Diabetes Mellitus (GDM) and to compare maternal fetal outcome between metformin and insulin in GDM. Methods: It is a prospective comparative study performed in a tertiary centre. 100 women diagnosed with gestational diabetes mellitus according to Diabetes in Pregnancy Study group of India (DIPSI) criteria at booking and/or between 24-28 weeks of gestation.These women were divided randomly into two groups, 50 patients in each group and they are subjected to pharmacological treatment with either insulin or metformin. Optimum glycemic control between the two groups is studied along with maternal and fetal outcome. Results: Our study to showed no significant difference in GDM with the use of metformin or insulin (P = 0.15). 84% of insulin group had good glycemic control whereas in metformin group, 72%, achieved euglycemic state. Maternal and fetal outcome are also comparable between the two groups. Conclusions: In GDM, glycaemic control can be done a combination of MNT (medical nutrition therapy), exercise and using the oral drug metformin without risk of teratogenicity or maternal hypoglycemia and with comparable neonatal outcome.
Could Metformin Manage Gestational Diabetes Mellitus instead of Insulin?
International Journal of Reproductive Medicine, 2016
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...
Is Metformin a Safe and Effective Treatment of Gestational Diabetes Mellitus?
Current Research in Diabetes & Obesity Journal
Background: Gestational diabetes mellitus (GDM) is associated with maternal and fetal/neonatal complications related to maternal hyperglycemia, which could be reduced thanks to an optimal glycemic control. The aim of our study was to evaluate maternal and neonatal outcomes in a cohort of women with GDM, in order to demonstrate metformin's safety and efficacy. Methods: We conducted a retrospective study of all women with GDM delivered in MBBM Foundation, San Gerardo Hospital, between 01/2009 and 06/2012, comparing pregnancy course and neonatal outcomes in women in diet to those treated with metformin. Exclusion criteria were multiple gestations and pregestational diabetes. Results: 763 patients were divided in 2 groups according to therapy: 593(78%) in diet group and 170(22%) in metformin one; 8(5%) of the latter group needed insulin addiction to control the disease. Preeclampsia and hypotiroidism were more frequent in metformin group, but the higher rate of preeclampsia was correlated only to chronic hypertension at the logistic regression analysis. Delivery mode was similar between the study groups, even if induction of labor was more frequent and gestational age at delivery was lower in the metformin group compared to diet one. At the logistic regression, an higher pre-gestational BMI and a lower GA at diagnosis resulted independent predictors of use of metformin. Considering neonatal outcomes, in diet group birth weight and gestational age at delivery were greater; considering rate of birth weight >4000, of small and large for gestational age there were no difference. Jaundice occurred more frequently in metformin group, while for other adverse neonatal outcomes no statistical differences were found between the groups. At the multivariate analysis, hyperbilirubinemia resulted independently related to the earlier gestational age at delivery and not to the use of metformin. Conclusion: Metformin can be a safe and effective pharmacological treatment for GDM in case of uncontrolled glycaemia with diet alone; although metformin is used in patients with a more severe form of GDM, it allows to obtain maternal and perinatal outcomes similar to patients with easier-to-treat GDM, requiring only diet.
Metformin compared to insulin for the management of gestational diabetic Production and Hosted by
2018
, this study included 150 women with singleton pregnancies diagnosed with gestational DM. The primary endpoints were neonatal outcomes which include; neonatal hypoglycemia (≥2 neonatal glucose values 46.8 m/dL), respiratory distress (admission to neonatal care unite NUC), need for phototherapy (neonatal jaundice), 5-minute Apgar scores below 7, or premature birth (<37 weeks of gestation). The maternal outcome includes the rate of gestational hyperten-sion, preeclampsia, mode of delivery and Polyhydramnios. Metformin offer less risk for the neonate to have an episode of blood glucose level <28.8 mg/dl compared to insulin RR (95%CI): 0.598 (0.457-0.999) and it was significant, metformin also offer less risk for the neonate to have recurrent blood glucose level <46.8 mg/dl RR (95%CI): 0.820 (0.586-1.289) but it was not statistically significant, metformin had slightly increased risk for preterm birth compared to insulin, the rest of the variables did not show a significant difference between both drugs. There was no significant difference in the maternal outcome between both drugs. There was no significant difference between met-formin and insulin in their FPG and HbA1c after commencing therapy. In conclusion , metformin is an effective and safe treatment option for women with GDM, and that metformin comparable with insulin in glycemic control, there is no a significant risk of maternal or perinatal adverse outcome with the use of metformin compared with insulin in GDM.
Treatment of Gestational Diabetes Mellitus: Insulin or Metformin?
Journal of Evolution of Medical and Dental Sciences, 2016
BACKGROUND Metformin has established as an ideal first-line treatment for type 2 diabetes and hypothetically a particularly attractive drug for use in pregnancy. Metformin is known to cross the placenta and its use in pregnancy has been limited by concerns regarding potential adverse effects on both the mother and the foetus. Randomised trials to assess the efficacy and safety of its use for Gestational Diabetes Mellitus (GDM) are lacking. METHODS Seventy six women with singleton pregnancy and diagnosed with GDM as per International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria were enrolled in study at 24 to 33 weeks of gestation. Subjects were randomly allocated to the intervention group (n=38) and active control group (n=38). Each subject in both groups received counseling on diet modification and physical activity, but failed to achieve glycaemic targets. Intervention group received metformin (with supplemental insulin if required). Active control group received human insulin (Regular, Neutral Protamine Hagedorn (NPH), or both). Primary outcome was neonatal birth weight. Secondary outcomes included maternal and neonatal complications with treatment satisfaction for allotted modality. RESULTS A total of 32 on metformin (Intervention group) and 33 on insulin (Active control group) subjects completed study. Of the 32 women assigned to metformin, 96.87% continued to receive metformin until delivery and 25% of the metformin group received supplemental insulin. There was no significant difference in mean birth weight between groups. There were no significant differences in neonatal and maternal complications between groups. However, treatment satisfaction (70.97%) was significantly better in metformin group whereas better control of postprandial plasma glucose was achieved in insulin group. CONCLUSIONS Metformin is an effective, safe, cheap, and convenient alternative to insulin in the treatment of GDM patients. However, to determine the predictors of the need for supplemental insulin in women treated with metformin, will require further study.
Journal of Clinical Medicine
Metformin is increasingly being used a therapeutic option for the management of gestational diabetes mellitus (GDM). The aim of this study was to compare the maternal characteristics and perinatal outcomes of women with GDM treated with metformin (with or without supplemental insulin) with those receiving other management approaches. A retrospective, case-control study was carried out and 83 women taking metformin were matched 1:1 with women receiving insulin or diet and lifestyle modification alone. Women managed with diet and lifestyle modification had a significantly lower fasting plasma glucose (p < 0.001) and HbA1c (p < 0.01) at diagnosis of GDM. Furthermore, women managed with metformin had a higher early pregnancy body mass index (BMI) compared to those receiving insulin or diet and lifestyle modification (p < 0.001). There was no difference in mode of delivery, birth weight or incidence of large-or small-for-gestational-age neonates between groups. Women receiving glucose lowering therapies had a higher rate of neonatal hypoglycaemia (p < 0.05). The incidence of other adverse perinatal outcomes was similar between groups. Despite their greater BMI, women with metformin-treated GDM did not have an increased risk of adverse perinatal outcomes. Metformin is a useful alternative to insulin in the management of GDM.
The journal of obstetrics and gynaecology research, 2017
We aimed to assess the use of metformin (MTF) in the prevention of gestational diabetes mellitus (GDM) in patients with pregestational insulin resistance (PIR). A double blind, multicenter, randomized trial was carried out in patients with a history of PIR and pregestational MTF treatment. Groups were allocated either to MTF 1700 mg/day or placebo. Patients were recruited between 12(+0) and 15(+6) gestational weeks, and treatment was extended until week 36. A multiple logistic regression analysis was applied to determine the relation between the use of metformin and the development of GDM. One hundred and forty one patients were randomized (68 patients in the MTF group and 73 in the placebo group). A total of 30 patients withdrew from the study during follow-up. Administration of MTF was not associated with a decrease in the incidence of GDM as compared to placebo (37.5% vs 25.4%, respectively; P = 0.2). Moreover, MTF administration was associated with a significant increase in dru...