Metformin combined with insulin in women with gestational diabetes mellitus: a propensity score-matched study

Abstract

Aim

Metformin use in gestational diabetes (GDM) is a common practice. Although its use in combination with insulin might be advantageous, it was never formally tested. We studied whether combined treatment was associated with better obstetric or neonatal outcomes compared to insulin alone.

Methods

This is a retrospective study, using the Portuguese National Registry of GDM (2012–2017), of women treated with insulin ± metformin. Primary endpoints were obstetric and neonatal complications. Secondary endpoints were gestational weight gain (GWG) and insulin dose. A propensity score-matched analysis was performed to balance the distribution of age, BMI, insulin treatment duration, HbA1c, first trimester diagnosis of GDM and previous GDM or macrosomia. Women treated with metformin plus insulin and insulin only were then compared.

Results

A total of 4034 women were treated with insulin or insulin plus metformin (10.2%). After propensity score matching, we studied two groups of 386 patients. Obstetric and neonatal complications were similar. Women treated with metformin plus insulin had 201 (52.1%) obstetric complications versus 184 (47.7%) in insulin-only group, p = 0.22; and 112 (29.0%) neonatal complications versus 96 (24.9%), p = 0.19. Patients treated with metformin plus insulin had similar GWG, excessive weight gain and insulin dose compared to the insulin-only group.

Conclusions

Women with GDM treated with insulin plus metformin had similar obstetric and neonatal complications, weight gained and insulin dose compared to those only treated with insulin.

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All authors whose names appear on the submission made substantial contributions to the conception, design of the work; the acquisition, analysis, and interpretation of data; drafted the work or revised it critically for important intellectual content; approved the version to be published; and agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

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Correspondence to Catarina Chaves.

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Even though we do not have a formal approval from a Bioethics Committee, this work refers to a retrospective observational study using data from a formal and well-established national gestational diabetes mellitus database. All data were anonymously collected and analysed.

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This article belongs to the topical collection Pregnancy and Diabetes, managed by Antonio Secchi and Marina Scavini

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Chaves, C., Cunha, F., Martinho, M. et al. Metformin combined with insulin in women with gestational diabetes mellitus: a propensity score-matched study. Acta Diabetol (2021). https://doi.org/10.1007/s00592-020-01665-8

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Keywords

  • Gestational diabetes mellitus
  • Metformin
  • Insulin
  • Obstetric complications
  • Neonatal complications