Gestational diabetes: metformin vs insulin

  • Bao LX & al.
  • J Matern Fetal Neonatal Med
  • 26 Sep 2019

  • curated by Sarfaroj Khan
  • UK Clinical Digest
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Takeaway

  • This meta-analysis suggests that metformin therapy for gestational diabetes mellitus (GDM) may have potential benefits with no increased risk for adverse maternal and neonatal outcomes compared with insulin.

Why this matters

  • Findings provide support for the regular use of metformin as a treatment strategy that can improve the management of GDM.

Study design

  • 24 studies (17 randomised controlled trials for quantitative analyses: n=2828; 7 studies for qualitative synthesis) met eligibility criteria after a search on PubMed, Embase and the Cochrane database.
  • Funding: None disclosed.

Key results

  • Metformin vs insulin therapy for GDM was associated with a reduced risk for:
    • pregnancy-induced hypertension (risk ratio [RR], 0.64; 95% CI, 0.44-0.95; P=.03);
    • large gestational age babies (RR, 0.82; 95% CI, 0.68-0.99; P=.04);
    • macrosomia (RR, 0.63; 95% CI, 0.45-0.90; P=.01);
    • neonatal hypoglycaemia (RR, 0.72, 95% CI, 0.59-0.88; P=.001); and
    • neonatal intensive care unit admission (RR, 0.74; 95% CI, 0.58-0.94; P=.01).
  • Metformin use did not increase the risk for:
    • premature delivery (RR, 1.28; 95% CI, 0.95-1.73; P=.11);
    • pre-eclampsia (RR, 0.89; 95% CI, 0.65-1.21; P=.45);
    • caesarean delivery (RR, 0.94; 95% CI, 0.85-1.04; P=.20); and
    • small for gestational age babies (RR, 0.99; 95% CI, 0.69-1.42; P=.95).

Limitations

  • Lack of uniformity for GDM.