Metformin better than insulin for blood sugar control after meals in gestational diabetes: Study
Spain: A recent study comparing metformin and insulin treatment in women with gestational diabetes found metformin to be associated with a better postprandial blood sugar control for some meals. Treatment with metformin also leads to less maternal weight gain, a lower risk of hypoglycemic episodes, and a low failure rate as an isolated treatment.
The findings of the study are published in the American Journal of Obstetrics and Gynecology.
Women with gestational diabetes whose condition is not properly treated with diet are commonly prescribed insulin. Several recently published studies have reported metformin to have similar obstetrical and perinatal outcomes as insulin. Nevertheless, not all clinical guidelines endorse its use, and clinical practice is heterogeneous.
Against the above background, Gabriel OLVEIRA-FUSTER, Department of Endocrinology and Nutrition, Hospital Regional Universitario de Málaga, IBIMA, Spain, and colleagues aimed to test if metformin could achieve the same glycemic control as insulin and similar obstetrical and perinatal results, with a good safety profile, in women with gestational diabetes not properly controlled with lifestyle changes.
The aim of this study was to test if metformin could achieve the same glycemic control as insulin and similar obstetrical and perinatal results, with a good safety profile, in women with gestational diabetes not properly controlled with lifestyle changes.
For this purpose, the researchers performed the MeDiGes study -- a multicenter, open-label, parallel arms, randomized clinical trial at two hospitals in Málaga (Spain). The trial enrolled 200 women (aged 18-45 years) with GDM who needed pharmacological treatment. They were randomized to receive metformin (n=100) or insulin (n=100) (Detemir and/or Aspart) in the second or third trimesters of pregnancy.
The main outcomes were: 1. glycemic control (mean glycemia, pre-prandial and postprandial) and hypoglycemic episodes, and 2. obstetrical and perinatal outcomes and complications (hypertensive disorders, type of labor, prematurity, macrosomia, large for gestational age, neonatal care unit admissions, respiratory distress syndrome, hypoglycemia, jaundice).
Key findings of the study include:
- Mean fasting and postprandial glycemia did not differ between groups, but postprandial glycemia was significantly better after lunch and/or dinner in the metformin-treated-group.
- Hypoglycemic episodes were significantly more common in the insulin-treated group (55.9% vs 17.7% on metformin, OR 6.118).
- Women treated with metformin gained less weight from the enrollment to the prepartum visit (36-37 gestational weeks) (1.35±3.21 vs 3.87±3.50 Kg).
- Labor inductions (MET 45.7% vs INS 62.5%, OR 0.506) and cesarean deliveries (MET 27.6% vs INS 52.6%, OR 0.345) were significantly lower in the MET-group.
- Mean birth weight, macrosomia and large for gestational age were not different between treatment groups, as well as babies' complications. The lower cesarean delivery rate for women treated with metformin was not associated with macrosomia, large or small for gestational age, or other complications of pregnancy.
"Metformin treatment was associated with a better postprandial glycemic control than insulin for some meals, a lower risk of hypoglycemic episodes, less maternal weight gain, and a low rate of failure as an isolated treatment. Most obstetrical and perinatal outcomes were similar between groups," wrote the authors.
Reference:
The study titled, "MeDiGes Study. Metformin versus insulin in gestational diabetes: Glycemic control, and obstetrical and perinatal outcomes. Randomized prospective trial," is published in the American Journal of Obstetrics and Gynecology.
DOI: https://www.ajog.org/article/S0002-9378(21)00459-2/abstract#%20
