Metformin compared to insulin for the management of gestational diabetic

Abstract

A prospective comparative two arms study done in Al Kadhimiya teaching hospital for 1 year duration from January 2017 till January 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 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, 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 out- come between both drugs. There was no significant difference between metformin 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.