Metformin in Gestational Diabetes: The Offspring Follow-Up (MiG TOFU)

Abstract

OBJECTIVEIn women with gestational diabetes mellitus, who were randomized to metformin or insulin treatment, pregnancy outcomes were similar (Metformin in Gestational diabetes [MiG] trial). Metformin crosses the placenta, so it is important to assess potential effects on growth of the children.RESEARCH DESIGN AND METHODSIn Auckland, New Zealand, and Adelaide, Australia, women who had participated in the MiG trial were reviewed when their children were 2 years old. Body composition was measured in 154 and 164 children whose mothers had been randomized to metformin and insulin, respectively. Children were assessed with anthropometry, bioimpedance, and dual energy X-ray absorptiometry (DEXA), using standard methods.RESULTSThe children were similar for baseline maternal characteristics and pregnancy outcomes. In the metformin group, compared with the insulin group, children had larger mid-upper arm circumferences (17.2 ± 1.5 vs. 16.7 ± 1.5 cm; P = 0.002) and subscapular (6.3 ± 1.9 vs. 6.0 ± 1.7 mm; P = 0.02) and biceps skinfolds (6.03 ± 1.9 vs. 5.6 ± 1.7 mm; P = 0.04). Total fat mass and percentage body fat assessed by bioimpedance (n = 221) and DEXA (n = 114) were not different.CONCLUSIONSChildren exposed to metformin had larger measures of subcutaneous fat, but overall body fat was the same as in children whose mothers were treated with insulin alone. Further follow-up is required to examine whether these findings persist into later life and whether children exposed to metformin will develop less visceral fat and be more insulin sensitive. If so, this would have significant implications for the current pandemic of diabetes.

Metformin – újabb adatok egy megbízható és hatékony „régi” vércukorcsökkentő készítményről

“…Az utóbbi időben -a T2DM kezelésében hosszú ideje betöltött helyének [3][4][5], bővülő indikációs körének [1,7,8] és az adása biztonságos voltával kapcsolatos újabb ismereteknek megfelelően [2,[23][24][25]37, 39] -rohamosan nő a metforminnal foglalkozó közlemények száma. Alkalmazása iránt megnőtt a társszakmák érdeklődése is [7, 9-11, 34, 38, 40].…”

Efficacy and safety of metformin for the treatment of gestational diabetes: a new approach to the problem

“…Наиболее крупным на сегодняшний день явля-ется исследование MiG TOFU (Metformin in gestational diabetes: The offspring follow-up) [36] -продолжение из-вестного исследования MiG, посвященное проблеме оценки долгосрочных прогнозов у детей, подвергав-шихся действию метформина внутриутробно, по срав-нению с группой инсулинотерапии. По данным этого исследования было показано, что в возрасте 2 лет у детей, получавших внутриутробно метформин, была более толстая кожная складка в области плеча и лопатки по сравнению с группой детей, чьи матери во время бере- …”

The diversity of gestational diabetes: a therapeutic challenge

“…The follow-up results from the MIG-study at 2 years 41 indicate that the metformin treatment may influence neonatal fat distribution. However, fat mass was only increased in the extremities and not viscerally, which was interpreted as beneficial.…”