Comparison of Metformin with Insulin in the Management of Gestational Diabetes

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