Abstract
Background
Insulin therapy though time-tested and effective option requires a certain degree of expertise (or training) and storage precautions. Metformin is cheap, orally taken, and does not cause hypoglycemia. Controversy exists regarding safety and efficacy of metformin therapy during pregnancy.
Methods
Newly diagnosed women with GDM as per IADPSG criteria requiring drug therapy were randomized to either metformin or insulin after informed consent. Each group has 80 to show 8 mg difference in blood sugar control. Maternal and fetal outcomes were noted and maternal satisfaction to therapy was assessed by pre-determined questionnaire. Comparison of continuous variables was done by Student t test and categorical variables by chi-square test.
Results
Control of blood sugar was achieved in 71% of Insulin group and 76% of metformin group and the difference is not statistically significant. Sixteen percent of women in metformin group needed insulin. No difference in maternal outcomes of hypertension, preterm labor, and cesarean section rate. Neonatal hypoglycemia occurred in 6.25% of insulin group and 1.25% of metformin group and 28% of new-borns of insulin group needed NICU care when compared to 11% of metformin group. Eighty percent of metformin group and 31% of insulin group opined to take metformin as initial drug of choice.
Conclusion
Metformin is as effective as insulin for control of blood sugar in women with GDM. Obese women and GDM diagnosed in first and second trimester may require addition of Insulin later. Most of the women preferred oral therapy with metformin initially and add insulin if needed.
Similar content being viewed by others
References
Munshi S, Khandaker S. Evaluations of Metformin versus insulin in the management of gestational diabetes mellitus: a prospective comparative study. Int J Reprod Contracept Obstet Gynecol. 2014;3:357–61.
Metformin Use During pregnancy/Drugs.com(internet) (cited 2014 Jul 29). Available from: http://www.drugs.com/pregnancy/metformin.html
Renda E, Rfaraci M, Di prima FAF, Valenti O. Treatment of gestational diabetes: oral hypoglycaemic agents or insulin. Journal of Prenatal Medicine.2011;5:63-64.
Hellmuth E, Damm P, Molsted-pederson L. Oral hypoglycaemic agents in 118 diabetic pregnancies. Diabet Med. 2000;17:507–11.
Rowan J, Hague W, Gao W, battin M, Moore M, MiG trail investigators: Metformin versus Insulin for treatment of Gestational Diabetes N. Engl J Med. 2008;358:2003-15.
Rai L, Meenakshi D, Kamath A, Metformin—a convenient alternative to insulin foe Indian Women with diabetes in pregnancy. Indian J Med Sci. 2009;63:491-497.
Diabetes Association. Gestational Diabetes Mellitus-2002. Diabetes Care. 2002;25:S94–6.
Glueck C, Phillips H, Cameron D, Sieve-Smith L, Wang P. Continuing metformin throughout pregnancy in women with polycystic ovary syndrome appears to safely reduce first trimester spontaneous abortion: a pilot study. Fertile Steril. 2001;75:46–52.
Papa D, Habeebullah S. Maternal and fetal outcome in gestational diabetes mellitus treated with diet and metformin—a preliminary retrospective analysis. The Open Conference Proceeding Journal. 2011;2:59-63.
Mesdaghinia E, Samimi M, Homaei Z, Saberi F, Moosavi SG, Yaribakht M. Comparision of newborn outcomes in women with gestational diabetes mellitus treated with metformin or insulin: a randomised blinded trial. Int J Prev Med. 2013;4(3):327–33.
Spaulonci CP, Bernardes LS, Trindade TC, Zugaib M, Francisco RP. Randomized trial of metformin vs insulin in the management of gestational diabetes. Am J Obstet Gynecol. 2013 Jul; 209(1):34.e1-7.
Mohammad Galal, Walaa Mohammad El Bassioune and Lobna Sherif, 2019. Metformin versus insulin in treatment of gestational diabetes mellitus: a randomized controlled trial. Research Journal of Obstetrics and Gynecology 2019. 12: 23-27.
Gui J, Liu Q, Feng L. Metformin vs insulin in the management of gestational diabetes: a meta-analysis. PLOS ONE. 2013;8(5):e64585. https://doi.org/10.1371/Journal.prone.0064585.
Zhu B, Zhang L, Fan YY, Wang L, Li XG, Liu T, Cao YS, Zhao ZG. Metformin versus insulin in gestational diabetes mellitus: a meta-analysis of randomized clinical trials. Ir J Med Sci. 2016 May;185(2):371–81. https://doi.org/10.1007/s11845-016-1414-x Epub 2016 Feb 9.
Bao LX, Shi WT, Han YX. Metformin versus insulin for gestational diabetes: a systematic review and meta-analysis. J Matern Fetal Neonatal Med. 2019 Sep;26:1–13. https://doi.org/10.1080/14767058.2019.1670804.
Gandhi P, Bustani R, Madhuvrata P, Farrell T. Introduction of metformin for gestational diabetes mellitus in clinical practice: Has it had an impact? Eur J Obstet Gynecol Reprod Biol. 2012;160:147–50.
Author information
Authors and Affiliations
Contributions
PD–concept and protocol preparation, data collection, and analysis. BG—data collection. KK—statistical analysis.
Corresponding author
Ethics declarations
Conflict of interest
The authors declare no conflict of interest.
Additional information
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Dasari, P., Gundagurti, B. & Karthikeyan, K. Comparison of metformin and insulin therapy for the treatment of gestational diabetes mellitus—a randomised controlled trial. Int J Diabetes Dev Ctries 43, 523–528 (2023). https://doi.org/10.1007/s13410-022-01048-5
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s13410-022-01048-5