Factors Associated with the Need for Insulin as a Complementary Treatment to Metformin in Gestational Diabetes Mellitus.

Jean Carl Silva,Larissa Cano De Oliveira,Iramar Baptistella Do Nascimento,Matheus Leite Ramos De Souza,Rodrigo Ribeiro E Silva,Thiago Ribeiro E Silva,Guilherme Dienstmann

doi:10.1055/s-0039-1700796

Abstract

To evaluate the factors associated with the need for insulin as a complementary treatment to metformin in pregnant women with gestational diabetes mellitus (GDM). A case-control study was performed from April 2011 to February 2016 with pregnant women with GDM who needed complementary treatments besides diet and physical exercise. Those treated with metformin were compared with those who, in addition to metformin, also needed the combination with insulin. Maternal characteristics and glycemic control were evaluated. Multinomial logistic regression models were developed to evaluate the influence of different therapies on neonatal outcomes. A total of 475 pregnant women who needed pharmacological therapy were evaluated. Of these, 366 (77.05%) were submitted to single therapy with metformin, and 109 (22.94%) needed insulin as a complementary treatment. In the analysis of the odds ratio (OR), fasting glucose (FG) < 90 mg/dL reduced the odds of needing the combination (OR: 0.438 [0.235-0.815]; p = 0.009], as well as primiparity (OR: 0.280 [0.111-0.704]; p = 0.007]. In obese pregnant women, an increased chance of needing the combination was observed (OR: 2,072 [1,063-4,039]; p = 0,032). Obesity resulted in an increased chance of the mother needing insulin as a complementary treatment to metformin, while FG < 90 mg/dL and primiparity were protective factors.

Highlights

The sample was composed of pregnant women with Gestational diabetes mellitus (GDM), and those who needed only treatment with metformin were compared with pregnant women treated with metformin who needed to be associated with insulin
A total of 475 pregnant women were enrolled in the study, 366 (77.05%) of whom used only metformin as pharmacological therapy for GDM, and 109 (22.95%) needed insulin to complement the metformin
We identified that the pregnant women with higher values of fasting glucose (FG) in the oral glucose tolerance test (OGTT) belonged to the group that represented the failure of the metformin monotherapy

Summary

Introduction

Gestational diabetes mellitus (GDM) is a metabolic alteration with prevalence between 3% and 25%, depending on the ethnic group and the diagnostic criteria used.[1,2] In the last decades, there has been a progressive increase in the number of pregnant women diagnosed with diabetes as a result of population growth, increased maternal age, lack of physical activity, and an increased prevalence of obesity.[3]The maternal hyperglycemia that is a characteristic of GDM has a negative impact on the progression of pregnancy.[4,5] GDM is an independent risk factor for obstetric complications, such as: preterm delivery; preeclampsia; large for gestational age (LGA) newborns and macrossomics; birth traumas, such as dystocia; increased need for cesarean sections; and neonatal hypoglycaemia.[6,7]The initial treatment recommended is lifestyle changes, such as diet and physical activity.[8,9] When such measures are not sufficient to reach adequate glucose levels, pharmacological therapy is required, with metformin or insulin.[10]. It is believed that 15% to 60% of patients require pharmacological treatment in combination with diet and physical activity to achieve control of the condition.[11]

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Discussion

Conclusion