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Diabetes Res Clin Pract. 2015 Sep;109(3):521-32. doi: 10.1016/j.diabres.2015.05.017. Epub 2015 May 14.

Metformin for the treatment of gestational diabetes: An updated meta-analysis.

Author information

1
Social and Administrative Pharmacy Program, Faculty of Pharmaceutical Sciences, Khon Kaen University, Thailand.
2
Clinical Pharmacy Research Unit, Faculty of Pharmacy, Mahasarakham Univeristy, Thailand.
3
Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine, Chiang Mai University, Thailand.
4
Bone and Mineral Research Program, Garvan Institute of Medical Research, Sydney, Australia.
5
Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine, Khon Kaen University, Thailand. Electronic address: pchatl@kku.ac.th.

Abstract

OBJECTIVE:

To assess the efficacy of metformin and insulin in the treatment of pregnant women with gestational diabetes mellitus (GDM).

METHODS:

A meta-analysis was conducted by including randomized controlled trials comparing metformin and insulin in GDM. An electronic search was conducted to identify relevant studies. Data were synthesized by a random effects meta-analysis model. A Bayesian analysis was also performed to account for uncertainties in the treatment efficacy.

RESULTS:

Eight clinical trials involving 1712 individuals were included in the final analysis. The pooled estimates of metformin-insulin differences were very small and statistically non-significant in fasting plasma glucose, postprandial plasma glucose and HbA1c, measured at 36-37 weeks of gestation. Notably, 14-46% of those receiving metformin required additional insulin. Compared with the insulin group, metformin treatment was associated with a lower incidence of neonatal hypoglycemia (relative risk, RR 0.74; 95% CI 0.58-0.93; P=0.01) and of neonatal intensive care admission (RR 0.76; 95% CI 0.59-0.97; P=0.03). Bayesian analysis revealed that the efficacy of metformin was consistently higher than insulin with a probability of over 98% on these two neonatal complications. Other outcomes were not significantly different between the two treatment groups.

CONCLUSION:

In women with gestational diabetes, metformin use and insulin therapy have comparable glycemic control profile, but metformin use was associated with lower risk of neonatal hypoglycemia.

KEYWORDS:

Gestational diabetes mellitus; Insulin; Metformin; Oral hypoglycemic agent

PMID:
26117686
DOI:
10.1016/j.diabres.2015.05.017
[Indexed for MEDLINE]

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