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To compare the effectiveness of metformin and insulin in terms of glycemic control, obstetrical and perinatal outcomes in cases of gestational diabetes mellitus (GDM) not appropriately controlled with lifestyle modifications.
Even though most of the obstetrical and
perinatal results were alike amongst women on metformin and insulin, but this
randomized prospective trial found metformin to be effective in terms of
improved postprandial glycemic control, reduced incidences of low blood sugar,
low maternal weight gain, and a low failure rate.
To compare the
effectiveness of metformin and insulin in terms of glycemic control,
obstetrical and perinatal outcomes in cases of gestational diabetes mellitus
(GDM) not appropriately controlled with lifestyle modifications.
Two hundred women with GDM aged 18-45 years,
in the second or third trimesters were randomized to receive metformin
(metformin-treated group) or insulin (insulin-treated group) with 100 patients
in each. The main outcomes were:
Patients in the
metformin group had significantly better postprandial glycemia following lunch
and/or dinner than insulin. Hypoglycemic episodes were considerably more common
in the insulin-treated group (55.9%) than metformin (17.7%). Women on metformin
treatment gained less weight from the study registration to the prepartum visit
(36 to 37 gestational weeks). Also, these women had significantly lesser labor
inductions and cesarean deliveries. Lower cesarean delivery rate for women on
metformin was not linked with large or small for gestational age or macrosomia,
or other pregnancy associated complications.
As compared to
insulin, metformin leads to better postprandial glycemic control for some meals
alongwith a lower risk of hypoglycemic episodes, less maternal weight gain, and
low failure rate when used alone.
American Journal of Obstetrics and Gynecology
MeDiGes Study. Metformin versus insulin in gestational diabetes: Glycemic control, and obstetrical and perinatal outcomes. Randomized prospective trial
María J Picón-César et al.
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