Metformin for the treatment of gestational diabetes: An updated meta-analysis
OBJECTIVE: To assess the efficacy of metformin and insulin in the treatment of pregnant women with gestational diabetes mellitus (GDM). METHODS: A meta-analysis was conducted by including randomized controlled trials comparing metformin and insulin in GDM. An electronic search was conducted to identify relevant studies. Data were synthesized by a random effects meta-analysis model. A Bayesian analysis was also performed to account for uncertainties in the treatment efficacy. RESULTS: Eight clinical trials involving 1712 individuals were included in the final analysis. The pooled estimates of metformin-insulin differences were very small and statistically non-significant in fasting plasma glucose, postprandial plasma glucose and HbA1c, measured at 36-37 weeks of gestation. Notably, 14-46% of those receiving metformin required additional insulin. Compared with the insulin group, metformin treatment was associated with a lower incidence of neonatal hypoglycemia (relative risk, RR 0.74; 95% CI 0.58-0.93; P=0.01) and of neonatal intensive care admission (RR 0.76; 95% CI 0.59-0.97; P=0.03). Bayesian analysis revealed that the efficacy of metformin was consistently higher than insulin with a probability of over 98% on these two neonatal complications. Other outcomes were not significantly different between the two treatment groups. CONCLUSION: In women with gestational diabetes, metformin use and insulin therapy have comparable glycemic control profile, but metformin use was associated with lower risk of neonatal hypoglycemia.
|ISBN||1872-8227 (Electronic) 0168-8227 (Linking)|
|Authors||Kitwitee, P.; Limwattananon, S.; Limwattananon, C.; Waleekachonlert, O.; Ratanachotpanich, T.; Phimphilai, M.; Nguyen, T. V.; Pongchaiyakul, C.;|
|Responsible Garvan Author|
|Publisher Name||DIABETES RESEARCH AND CLINICAL PRACTICE|
|URL link to publisher's version||http://www.ncbi.nlm.nih.gov/pubmed/26117686|
|OpenAccess link to author's accepted manuscript version||https://publications.gimr.garvan.org.au/open-access/13202|