Comparison of pregnancy outcome with use of metformin versus insulin in management of gestation diabetes mellitus: An interventional study
Abstract
Gestational Diabetes Mellitus (GDM) is a problem which may occur during pregnancy. For treatment of GDM either the Metformin or Insulin is used. So this prospective randomized multicenter trial in women with GDM was conducted to compare the treatment outcomes of metformin and insulin. This study was conducted at Rajkiya Mahila Chikitsalaya, in Obstetrics & Gynaecology Department of Jawaharlal Nehru Medical College, Ajmer. This study was done on 110 women who were diagnosed GDM by DIPSI criteria with a singleton pregnancy and meet entry criteria are randomized to insulin or metformin treatment (55 cases in each group).It was observed that metformin is equally efficacious and safe as insulin with a lot of advantages like less costly, better compliance, less weight gain, less change of hypoglycaemic attack and more feasible as insulin require several daily injection with not much difference in perinatal outcome except statistically significant difference in baby weight, mean cord blood sugar level at birth, large for gestation age. So it can be concluded that Metformin treatment is suitable for non-obese as well as obese type 2 diabetes patients in pregnancy without complications. Metformin is a safer alternate to insulin in GDM management with no adverse maternal and fetal outcome.
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Introduction
Gestational Diabetes Mellitus (GDM) is defined as any degree disturbance of glucose metabolism with onset or first recognition during pregnancy. 1,2 The prevalence of GDM varies worldwide from 1 to 25% according to the ethnic population and the criteria used in the diagnosis.3 Screening policies regarding GDM and the diagnostic criteria vary according to the different recommendations. 4
The initial recommendation for using 75-g Oral Glucose Tolerance Test (OGTT) in pregnancy was from the World Health Organization (WHO). The WHO used the same criteria for diagnosing diabetes both during and outside of pregnancy. 5 This approach was criticized, as it ignored the physiological changes in carbohydrate metabolism that occurs during pregnancy. In 1999, the WHO lowered the threshold for FPG from 7.8 mmol/L (140 mg/dL) to 7.0 mmol/L (126 mg/dL) and recommended that pregnant women meeting the criteria for diabetes mellitus or impaired glucose tolerance (IGT) be classified as having GDM5 . The current 75-g International Association of the Diabetes and Pregnancy Study Groups criteria (IADPSG) criteria have been devised keeping this fact in mind and evaluating evidence that associates abnormal glucose tolerance in pregnancy with adverse perinatal outcomes. 6
Unblinded studies since 1995 have shown adverse perinatal outcomes to be linearly linked with glycemic levels in gestation7 . The landmark study in this respect was the Hyperglycemia and Adverse Pregnancy Outcome (HAPO) study8 .
Conclusion
This study concludes that Metformin is an effective treatment option for women with GDM/type 2 diabetes in pregnancy with or without add-on insulin who require pharmacological treatment for glycemic control in our resource poor setting. Metformin has advantages over insulin such as less maternal weight gain, no maternal hypoglycemia, being less costly, being oral therapy and requiring no vigorous monitoring and frequent hospital admissions with good compliance and acceptability. So, Metformin can be used in the management of gestational diabetes mellitus.