Treatment of Gestational Diabetes Mellitus: Insulin or Metformin?

Somani, Prashant Subhash; Sahana, Pranab Kumar; Chaudhuri, Picklu; Sengupta, Nilanjan

doi:10.14260/jemds/2016/1011

Cited by 7 publications

(4 citation statements)

References 38 publications

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“…In an RCT by Somani et al with no differences in glycemic outcomes between the metformin and insulin groups at baseline, higher PPG levels were reported in group treated with insulin compared to those treated with metformin ( p = 0.005) [ 26 ]. In an RCT by Ji et al with mixed population, a significant improvement in PPG and time in range (TIR) was observed with insulin detemir compared to insulin neutral protamine Hagedorn (NPH) ( p < 0.001) [ 27 ].…”

Section: Resultsmentioning

confidence: 99%

“…Most included trials reported no difference in the proportion of cesarean sections among women treated with metformin versus insulin [ 21 , 24 , 26 , 33 – 39 ]. However, two RCTs by Galal et al and Hassan et al reported a significantly higher rate ( p ≤ 0.05) of cesarean sections in the insulin-treated group [ 20 , 40 ], while an RCT by Ijas et al reported a lower rate of cesarean section in the insulin-treated group versus metformin ( p = 0.047) [ 41 ].…”

Section: Resultsmentioning

confidence: 99%

“…In another RCT, Somani et al compared stillbirth in women treated with insulin (regular or NPH or both) versus metformin. This trial reported one case of stillbirth in the insulin-treated group compared to no stillbirth in the metformin group ( p = 0.32) [ 26 ].…”

Section: Resultsmentioning

confidence: 99%

“…The primary outcomes of interest were different across the included studies. Most included trials reported no difference in the proportion of cesarean sections among women treated with metformin versus insulin [21,24,26,[33][34][35][36][37][38][39] [20,39,40]. In women with pre-existing diabetes, an open-label, randomized study by Ainuddin et al reported a significantly high rate of incidence of pregnancy-induced hypertension in the insulintreated group compared to only metformin group and metformin and insulin-treated group [44], while an RCT by Ji et al demonstrated a numerically higher incidence of gestational hypertension in the insulin NPH-treated group compared to the insulin detemir-treated-group [27].…”

Section: Evidence From Clinical Trialsmentioning

confidence: 99%

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Insulin Use During Gestational and Pre-existing Diabetes in Pregnancy: A Systematic Review of Study Design

Castorino,

Osumili,

Lakiang

et al. 2024

Diabetes Ther

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Introduction Insulin is the first-line pharmacologic therapy for women with diabetes in pregnancy. However, conducting well-designed randomized clinical trials (RCTs) and achieving recommended glycemic targets remains a challenge for this unique population. This systematic literature review (SLR) aimed to understand the evidence for insulin use in pregnancy and the outcome metrics most often used to characterize its effect on glycemic, maternal and fetal outcomes in gestational diabetes mellitus (GDM) and in pregnant women with diabetes. Methods An SLR was conducted using electronic databases in Medline, EMBASE via Ovid platform, evidence-based medicine reviews (2010–2020) and conference proceedings (2018–2019). Studies were included if they assessed the effect of insulin treatment on glycemic, maternal or fetal outcomes in women with diabetes in pregnancy. Studies on any type of diabetes other than gestational or pre-existing diabetes as well as non-human studies were excluded. Results In women diagnosed with GDM or pre-existing diabetes, most studies compared treatment of insulin with metformin ( n = 35) followed by diet along with lifestyle intervention ( n = 24) and glibenclamide ( n = 12). Most studies reporting on glycemic outcomes compared insulin with metformin ( n = 22) and glibenclamide ( n = 4). Fasting blood glucose was the most reported clinical outcome of interest. Among the studies reporting maternal outcomes, method of delivery and delivery complications were most commonly reported. Large for gestational age, stillbirth and perinatal mortality were the most common fetal outcomes reported. Conclusion This SLR included a total of 108 clinical trials and observational studies with diverse populations and treatment arms. Outcomes varied across the studies, and a lack of consistent outcome measures to manage diabetes in pregnant women was observed. This elucidates a need for global consensus on study design and standardized clinical, maternal and fetal outcomes metrics. Supplementary Information The online version contains supplementary material available at 10.1007/s13300-024-01541-6.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Evidence From Clinical Trialsmentioning

confidence: 99%

See 2 more Smart Citations

Insulin Use During Gestational and Pre-existing Diabetes in Pregnancy: A Systematic Review of Study Design

Castorino,

Osumili,

Lakiang

et al. 2024

Diabetes Ther

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Effects of Different Glucose-Lowering Measures on Maternal and Infant Outcomes in Pregnant Women with Gestational Diabetes: A Network Meta-analysis

Ouyang

2021

Diabetes Ther

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Introduction: A network meta-analysis was conducted to compare and rank the effects of different glucose-lowering measures on maternal and infant outcomes in pregnant women with gestational diabetes mellitus (GDM). Methods: We searched the PubMed, CNKI, Embase, Cochrane Library, Wanfang, and Weipu databases for relevant studies published between database establishment and June 2021. Study retrieval involved subject-heading and keyword searches. Randomized controlled trials (RCTs) with different glucose-lowering treatments for GDM patients were included. The Cochrane tool was used to assess bias risk. Pairwise and network meta-analyses were used to compare and rank the effects of different hypoglycemic measures on maternal and infant outcomes in pregnant women with GDM.

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Impact of metformin treatment during pregnancy on maternal outcomes: a systematic review/meta-analysis

Tarry-Adkins

Ozanne

Aiken

2021

Sci Rep

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We systematically assessed the impact of metformin treatment on maternal pregnancy outcomes. PubMed, Ovid Embase, Medline, Web of Science, ClinicalTrials.gov and Cochrane databases were systematically searched (inception-1st February 2021). Randomised controlled trials reporting pregnancy outcomes in women randomised to metformin versus any other treatment for any indication were included. Outcomes included gestational weight gain (GWG), pre-eclampsia, gestational hypertension, preterm birth, gestational age at delivery, caesarean section, gestational diabetes, glycaemic control, and gastrointestinal side-effects. Two independent reviewers conducted screening, with a third available to evaluate disagreements. Risk-of-bias and GRADE assessments were conducted using Cochrane Risk-of-Bias and GRADE-pro software. Thirty-five studies (n = 8033 pregnancies) met eligibility criteria. GWG was lower in pregnancies randomised to metformin versus other treatments (1.57 kg ± 0.60 kg; I2 = 86%, p < 0.0001), as was likelihood of pre-eclampsia (OR 0.69, 95% CI 0.50–0.95; I2 = 55%, p = 0.02). The risk of gastrointestinal side-effects was greater in metformin-exposed versus other treatment groups (OR 2.43, 95% CI 1.53–3.84; I2 = 76%, p = 0.0002). The risk of other maternal outcomes assessed was not significantly different between metformin-exposed versus other treatment groups. Metformin for any indication during pregnancy is associated with lower GWG and a modest reduced risk of pre-eclampsia, but increased gastrointestinal side-effects compared to other treatments.

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Treatment of Gestational Diabetes Mellitus: Insulin or Metformin?

Cited by 7 publications

References 38 publications

Insulin Use During Gestational and Pre-existing Diabetes in Pregnancy: A Systematic Review of Study Design

Insulin Use During Gestational and Pre-existing Diabetes in Pregnancy: A Systematic Review of Study Design

Effects of Different Glucose-Lowering Measures on Maternal and Infant Outcomes in Pregnant Women with Gestational Diabetes: A Network Meta-analysis

Impact of metformin treatment during pregnancy on maternal outcomes: a systematic review/meta-analysis

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