Abstract
Objective: Purpose of this study is to determine the efficacy of metformin as opposed to insulin in management of gestational diabetes mellitus. Methodology: The study took place in department of Gynecology and Obstetrics, Nishtar Hospital,Multan from May 2017 to March 2019. Study design is experimental prospective comparative study. Ethical approval was obtained from Hospital Ethics Committee. Sample was calculated using non probability consecutive sampling technique. Total 770 Patients were randomly divided into two equal groups, group M (metformin) and Group I (insulin). Glycemic control, mode of delivery and associated medical complication were recognized as possible maternal outcomes while congenital anomalies (if any), macrosomia, hypoglycemia, hyperbilirubinemia were the neonatal outcomes assessed by clinical and laboratory investigations. These outcomes were subjected to statistical analysis by using computer software SPSS version 23. Percentages were calculated for dichotomous variables and range, mean and standard deviation was calculated for continuous data. Chi square and t-test were applied to compare the two groups. P value less than 0.05 was considered as significant. Results: Overall 100% (n=770) female patients were included, in this study; divided into two equal groups 50% (n=385) in each i.e. metformin (Group M) and insulin (Group I). Significant difference was found between age (p=0.000), gravidity (p=0.012), gestational age (p=0.000), BMI in early pregnancy (p=0.000), FBS at entry (p=0.000), FBS after treatment (p=0.000), HBA1c at entry (p=0.000), HBA1c after treatment (p=0.000), in groups. Association was found between Preeclampsia (p=0.000), Pre-term birth (p=0.000), Neonatal birth weight>4 (p=0.002), neonatal hypoglycemia (p=0.000), in groups. Conclusion: This study concludes that metformin is as much effective as insulin in management of gestational diabetes mellitus. Metformin when used securely can prove effective as it does not cause any congenital anomalies or maternal or neonatal complications. But insulin still remains the gold standard for treatment of gestational diabetes mellitus. Keywords: Diabetes Mellitus, Gestational Diabetes, Metformin, Insulin, Pregnancy DOI : 10.7176/JMPB/54-11 Publication date : April 30 th 2019
Highlights
Glucose intolerance of any level with onset or first identified during the pregnancy can be called as gestational diabetes [1]
This study concludes that metformin is as much effective as insulin in management of gestational diabetes mellitus
Insulin still remains the gold standard for treatment of gestational diabetes mellitus
Summary
Glucose intolerance of any level with onset or first identified during the pregnancy can be called as gestational diabetes [1]. Studies have shown a mother to fetus transfer of almost 10 to 16% in case of metformin [11] which poses a great risk to both mother and the fetus as chances of adverse effects in mothers and birth defects in newborn increases significantly This is the reason metformin has not been used widely in gestational diabetes management. Multiple studies have been performed in past in order to determine the efficacy and safety of metformin in management of gestational diabetes but most of these studies were cross-sectional and had smaller sample size which does not sufficiently describe the effect of metformin on maternal and neonatal outcomes. In this study our aim is to compare the efficacy of metformin with insulin therapy in gestational diabetes management, in terms of maternal and neonatal outcomes. Reference for this study was taken from a recent study performed by Hesham Borg et al [12]
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