Metformin versus Insulin in patients with gestational diabet
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A recent study comparing metformin and insulin treatment in women with gestational diabetes found metformin to be associated with a better postprandial blood sugar control for some meals.

The aim of this study was to test if metformin could achieve the same glycemic control as insulin and similar obstetrical and perinatal results, with a good safety profile, in women with gestational diabetes not properly controlled with lifestyle changes. The study was published in the American Journal Of Obstetrics and Gynecology.

The study was a randomized clinical trial, enrolling women with GDM who needed pharmacological treatment. Women aged 18-45 years, in the second or third trimesters of pregnancy, were randomized to receive metformin or insulin. The main outcomes were: 1. glycemic control and hypoglycemic episodes, and 2. obstetrical and perinatal outcomes and complications. 200 women were randomized, 100 to the insulin-treated group and 100 to the metformin-treated group.

--Mean fasting and postprandial glycemia did not differ between groups, but postprandial glycemia was significantly better after lunch and/or dinner in the metformin-treated group.

--Hypoglycemic episodes were significantly more common in the insulin-treated group.

--Women treated with metformin gained less weight from the enrollment to the prepartum visit.

--Labor inductions and cesarean deliveries were significantly lower in the MET group.

--Mean birth weight, macrosomia, and large for gestational age were not different between treatment groups, as well as babies’ complications.

Conclusively, metformin treatment was associated with a better postprandial glycemic control than insulin for some meals, a lower risk of hypoglycemic episodes, less maternal weight gain, and a low rate of failure as an isolated treatment. Most obstetrical and perinatal outcomes were similar between groups.

Source: https://doi.org/10.1016/j.ajog.2021.04.229
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