Metformin versus insulin treatment in gestational diabetes in pregnancy in a developing country. A randomized control trial

Abstract

AimTo compare treatment with metformin alone, metformin plus insulin and insulin alone in women with gestational diabetes (GDM). MethodA total of 150 gestational diabetic patients who fulfilled the eligibility criteria were included in this prospective randomized control open labeled study. A risk factor based screening was done followed by a GCT and then local GTT criteria from antenatal clinics. They were initially divided into two groups with odd numbers assigned to metformin treatment and even numbers to insulin treatment. Metformin and/or insulin treatment was given and target blood sugar levels aimed at FBS≤100mg/dl and postprandial levels ≤126mg/dl. Supplemental insulin was added to metformin treatment group to maintain the glycemic targets if required. Patients were followed until delivery and maternal fetal outcomes and pharmacotherapeutic characteristics were recorded on a performa. ResultsLess maternal weight gain was found in the metformin treated groups (9.8±1.5kg [metformin alone] vs. 9.8±1.4kg [metformin plus insulin] vs. 12.5±1.1kg [insulin alone] P<0.000). Preeclampsia was significantly less in metformin treated groups. There were no perinatal deaths in the study. Mean birth weight was significantly less in metformin treated groups (3.4±0.4kg vs. 3.3±0.5kg vs. 3.7±0.5kg P<0.01). Less neonatal morbidity was observed in metformin groups. 42.7% of patients required supplemental insulin (mean dose of 13.6±2 units) in the metformin group. Mean gestational age at which insulin was added was 31.8±5.9 weeks. ConclusionMetformin is an effective and cheap treatment option for women with gestational diabetes with or without supplemental insulin.