Metformin compared to insulin for the management of gestational diabetic

Mohammed, Mohanad Adel; Kadhim, Kadhim A.; Gasim, Gaith Ali; Fawzi, Hayder Adnan

doi:10.26452/ijrps.v9i3.1630

Cited by 6 publications

(5 citation statements)

References 19 publications

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“…There were 34 eligible studies conducted from year 2000 till 2019; 11 studies which compared glyburide and insulin,[ 12 13 16 18 19 21 23 27 30 31 32 ] 18 compared metformin with insulin[ 7 8 9 14 15 20 24 25 26 33 34 35 36 37 38 39 40 41 ] and 5 assessed the efficacy of metformin with glyburide[ 6 18 22 28 29 ] [ Table 1 ] including a total of 6935 pregnant women having GDM.…”

Section: Resultsmentioning

confidence: 99%

Comparison of neonatal and maternal outcomes of anti-diabetic drugs in the treatment of gestational diabetes mellitus

Shah

et al. 2022

Journal of Family Medicine and Primary Care

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The safety and efficacy of different anti-diabetic drugs are not clear because of the lack of sufficiently powered clinical trials. This network meta-analysis was conducted to compare the efficacy and safety of three anti-diabetic drugs (insulin, glyburide, and metformin), and rank them as per their efficiency to control glucose levels, pregnancy, and neonatal outcomes. The study design is a systematic review, meta-analysis, and network meta-analysis. After a systematic search of existing databases, 34 randomized controlled trials were selected for inclusion in the analysis. We did pairwise network meta-analysis to calculate standardized mean difference and odds ratio (OR) as the summary measures for numerical and dichotomous variables, respectively, by using random-effects model. Our key outcomes were incidence of neonatal hypoglycemia, respiratory distress syndrome, macrosomia, C-section, admission to neonatal intensive care unit (NICU) and mean differences in the birth weight of neonates, gestational age at birth, HbA1C levels, fasting blood sugar, large at gestational age, and post-prandial glucose. It was found that metformin significantly lowered the post-prandial levels of glucose as compared with both glyburide and insulin in pairwise analysis (SMD = 14.11 [23–4.8]; SMD = 22.45 [30–14]), respectively. There was a significant reduction in birth weights of babies whose mothers were administered metformin as compared with either glyburide or insulin. The proportion of neonates admission to NICU was significantly lower for metformin when compared with insulin [Log OR = 0.334 (0.0184, 0.6814))]. Large at gestational age was significantly lower for metformin as compared with both glyburide and insulin [log OR = 0.6882 (0.171, 1.329), log OR = 0.393 (0.00179, 0.8218)], respectively. Oral anti-diabetic drugs especially metformin performed better than both glyburide and insulin for all neonatal and maternal outcomes except that it significantly lowered the neonatal birth weight.

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Section: Resultsmentioning

confidence: 99%

Comparison of neonatal and maternal outcomes of anti-diabetic drugs in the treatment of gestational diabetes mellitus

Shah

et al. 2022

Journal of Family Medicine and Primary Care

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“…Several studies in the literature examined the currently investigated markers to varying degrees. [31–36] In Kassahun et al study in Ethiopia, a cross-sectional study that examined 136 pregnant women (46 with PE), all women were in their third trimester, and NLR showed poor ability to differentiate between PE and control (AUC = 0.609); however, NLR was the best parameter in the study according to receiver operator curve analysis. [37] NLR serves as an indicator of both systemic inflammation and endothelial dysfunction.…”

Section: Discussionmentioning

confidence: 99%

Role of hematological indices in predicting preeclampsia and its severity: retrospective case–control study

Al-Nuaimi

2024

Medicine

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Preeclampsia (PE) is a serious condition that threatens pregnancy with severe sequelae on both the mother and infant. Early detection of PE will lead to favorable outcomes, and using readily available markers like hematological indices is an attractive choice. Examine the diagnostic utility of hematological indices in pregnant women to predict preeclampsia and its severity. In a retrospective case–control study that included 252 women, all had their complete blood picture evaluated during their first and third trimesters as part of their outpatient antenatal care during their pregnancy. They were also divided into 3 groups: healthy pregnant women (control), non-severe PE, and severe PE, each involving 84 women. The changes in platelet to lymphocyte ratio (PLR) between 1st and 3rd trimesters showed an excellent ability to differentiate between severe PE and control (area under the curve = 0.954, cutoff ≤ ‐5.45%) and a good ability to differentiate between severe PE and non-severe PE (area under the curve = 0.841, cutoff ≤ ‐7.89%). Neutrophil to lymphocyte ratio showed a good to excellent ability to differentiate between severe PE and non-severe PE compared to control in the first and third trimesters and the percentage change between them. Changes in neutrophil to lymphocyte ratio and PLR strongly predict preeclampsia and its severity since they offer more predictive values than measuring NLP and PLR at different stages of pregnancy individually.

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“…[ 6 14 15 16 ] More recent studies also found that metformin was not associated with any maternal or fetal complications, except for a slight increase in the risk of preterm birth. [ 8 17 18 19 20 21 22 ] Recent meta-analysis studies also reported on the benefits of metformin on fetal outcomes, including lowered risk of neonatal hypoglycemia, large for gestational age babies, and shorter neonatal intensive care unit stay. [ 5 6 7 23 ]…”

Section: Discussionmentioning

confidence: 99%

Metformin Use in Gestational Diabetes

Daud

Mohiuddin

Ong

et al. 2021

Journal of Pharmacy and Bioallied Sciences

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Background: Metformin has been added in the Malaysian clinical practice guideline (CPG) as one of the first-line options in the management of gestational diabetes mellitus (GDM); however, the uptake on this practice among healthcare professionals is unknown. Objective: The objective of the study is to determine the awareness, attitude, and practice and their predictors on the use of metformin for GDM among healthcare professionals in Malaysia. Materials and Methods: This was a multicenter, cross-sectional study in three tertiary hospitals in Malaysia. Medical doctors and pharmacists working in several departments were invited to participate in a survey using self-administered questionnaires. Results: From 350 questionnaires distributed, 225 were completed by medical doctors (43.1%), pharmacists (40.4%), and specialists (7.5%). Less than 30% of them were aware on the option of using metformin as one of the first-line agents in GDM. Education level, department, and profession were found to be associated with the awareness level (P = 0.016, P = 0.004, and P = 0.001, respectively). 70.2% of the respondents showed a positive attitude toward metformin use in GDM. Only 64 (28.4%) of the respondents have prescribed/dispensed metformin for GDM before, although more than half will consider doing so in the future. Having postgraduate qualifications increased the likelihood of having a good awareness (odds ratio [OR]: 2.44, 95% confidence interval [CI] 1.23–4.85) and to consider prescribing/dispensing metformin for GDM patients (OR: 2.27, 95% CI 1.08–4.78). Conclusion: Despite a positive attitude toward metformin use in GDM among healthcare professionals in Malaysia, their awareness level on this practice was low as they currently prefer the use of insulin over metformin.

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Metformin compared to insulin for the management of gestational diabetic

Cited by 6 publications

References 19 publications

Comparison of neonatal and maternal outcomes of anti-diabetic drugs in the treatment of gestational diabetes mellitus

Comparison of neonatal and maternal outcomes of anti-diabetic drugs in the treatment of gestational diabetes mellitus

Role of hematological indices in predicting preeclampsia and its severity: retrospective case–control study

Metformin Use in Gestational Diabetes

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