Metformin versus Insulin in the Management of Pre-Gestational Diabetes Mellitus in Pregnancy and Gestational Diabetes Mellitus at the Korle Bu Teaching Hospital: A Randomized Clinical Trial

Abstract

ObjectiveTo determine if metformin monotherapy or metformin in combination with insulin is equally effective as insulin monotherapy at glycemic control in diabetes mellitus in pregnancy among Ghanaians.MethodsThis was a study involving 104 pregnant women with type 2 diabetes mellitus (T2DM) or gestational diabetes mellitus (GDM) at 20-30 weeks gestation. Participants were randomized into metformin and insulin treatment groups. Starting dose of metformin was 500 mg once a day and increased gradually over two (2) weeks, to meet glycemic targets. Insulin was added if targets could not be reached on metformin alone at maximum doses. Total daily dose of premixed insulin at initiation was calculated as 0.3 IU/kg body weight and titrated upwards to achieve glycemic control. Glycemic profile monitoring was done every two weeks.ResultsThe two hour post prandial blood glucose (2HPG) levels were significantly lower in the metformin group than the insulin group (p= 0.004).ConclusionThe findings of this study suggest that metformin monotherapy is effective in achieving glycemic targets in the management of diabetes in pregnancy. It is more effective than insulin in lowering the 2HPG level.Trial RegistrationAustralian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12614000942651

Risk of pre‐eclampsia in women taking metformin: a systematic review and meta‐analysis

“…This yielded a total of 19 studies. The selected studies compared women receiving metformin treatment with healthy women or women on a healthy diet ( n = 5) , placebo ( n = 4) or insulin ( n = 11) (one study, with three treatment arms, was included in both the metformin vs. control and the metformin vs. insulin analyses ). The participants of the selected studies included women with GDM ( n = 7) , women with Type 2 diabetes ( n = 1) , women with both GDM and Type 2 diabetes ( n = 3) , women with PCOS ( n = 6) and obese women ( n = 2) .…”

“…The characteristics of the 19 selected studies are described in detail in Table . Fourteen RCTs and five cohort studies were included. The baseline age range for all the women ( n = 3374) was 16–46 years, but most of the studies included women aged <35 years.…”

Very tight vs. tight control: what should be the criteria for pharmacologic therapy dose adjustment in diabetes in pregnancy? Evidence from randomized controlled trials

“…We identified 51 RCTs on therapy for GDM or pregestational diabetes, and assessed these for eligibility (Figure ) . Of them, 34 were excluded, and therefore 17 including 4230 women were included .…”

“…Carbohydrate disorders in pregnancy, including gestational diabetes mellitus (GMD) and pregestational diabetes mellitus (DM), are the most common morbidities complicating pregnancy, with short‐ and long‐term consequences to mothers, fetuses, and newborns. It has been estimated that up to 6–7% or more of all pregnancies are complicated by DM in pregnancy . The latest reports from the International Diabetes Federation estimate that, worldwide, approximately one in seven births in 2015 were complicated by some form of hyperglycemia during pregnancy .…”

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

“…После исследования MIG было опубликовано мно-жество РКИ, посвященных сравнению метформина с инсулином, которые в большинстве своем подтвердили данные MIG [16][17][18][19][20][21][22][23]. Единственным ключевым отли-чием стало отсутствие тенденции к преждевременному родоразрешению в группе пациенток на метформине, которое было показано в MIG.…”