Evaluation of metformin versus insulin in the management of gestational diabetes mellitus: a prospective comparative study
Keywords:
Gestational diabetes mellitus, Metformin, InsulinAbstract
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.
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References
Glueck C, Goldenberg N, Streicher P, Wang P. Metformin and gestational diabetes mellitus. Curr Diabet Rep. 2003;3:303-12.
Jovanovic L, Pettitt D. Gestational diabetes mellitus. J Am Med Assoc. 2001;286:2516-8.
Ben-Haroush A, Yogev Y, Hod M. Epidemiology of gestational diabetes mellitus and its association with type 2 diabetes. Diabet Med. 2004;21:103-13.
Kim C, Newton K, Knopp R. Gestational diabetes and the incidence of type 2 diabetes. Diabet Care. 2002;25:1862-8.
Crowther C, Hiller J, Moss J, McPhee A, Jeffries W, Robinson J. Effect of treatment of gestational diabetes mellitus on pregnancy outcomes. N Eng J Med. 2005;352:2477-86.
Langer O. Is normoglycemia the correct threshold to prevent complications in the pregnant diabetic patient? Diabet Rev. 1996;4:2-10.
Langer O. From educated guess to accepted practice: the use of oral anti-diabetic agents in pregnancy. Clin Obstet Gynecol. 2007;4:959-71.
Kirpichinikov D, McFarlane S, Sowers J. Metformin: an update. Ann Intern Med. 2002;137:25-33.
Nanovskaya T, Nekhayeva I, Partikeeva S, Hankins G, Ahmed M. Transfer of metformin across the dually perfused human placental lobule. Am J Obstet Gynecol. 2006;195:1081-5.
Kovo M, Haroutiunian S, Feldman N, Hoffman A, Glezerman M. Determination of metformin transfer across the placenta cotyledons model. Euro J Obstet Gynecol Reprod Biol 2008;136:29-33.
Gilbert C, Valois M, Koren G. Pregnancy outcome after first-trimester exposure to metformin: a meta-analysis. Fertil Steril. 2006;86:658-63.
Hellmuth E, Damm P, Molsted-Pedersen L. Oral hypoglycemic agents in 118 diabetic pregnancies. Diabet Med. 2000;17(7):507-11.
Jacubowicz D, Iuorno M, Jacubowicz S, Roberts K, Nestler J. Effects of metformin on early pregnancy loss in the polycystic ovary syndrome. J Clin Endocrinol Metab. 2002;87:524-9.
Moore L, Briery C, Clokey D, Martin R, Willford N, Bofill.J, Morrison J. Metformin and insulin in the management of gestational diabetes mellitus. J Reprod Med. 2007;52:1011-5.
Rowan J, Hague W, Gao W, Battin M, Moore M. MiG trial investigators: metformin versus insulin for the treatment of gestational diabetes. N Eng J Med. 2008;358:2003-15.
