Metformin--a convenient alternative to insulin for Indian women with diabetes in pregnancy.
OBJECTIVE
To compare the use of metformin with that of insulin for the treatment of gestational diabetes mellitus (GDM) and type 2 diabetes mellitus (T2DM) unresponsive to diet therapy.


METHODS
In this prospective observational study, maternal glycemic control and perinatal outcome in diabetic pregnancies were compared between 2 obstetric units, one using insulin therapy and the other using metformin therapy. Baseline pretreatment glycemic profile was done and then repeated weekly throughout pregnancy. The outcome measures studied were glycemic control, maternal complications and perinatal outcome.


RESULTS
Sixty women with gestational and type 2 diabetes were enrolled, 30 each for metformin and insulin. Both groups were comparable with respect to age, body mass index (BMI), parity and pretreatment plasma glucose levels. Glycemic control was better with metformin after 1 week of therapy and also throughout gestation (P = 0.03-0.007). There were no major complications or perinatal deaths in this study. Mean gestational age and birth weight (2.9 +/- 0.4 kg versus 3.1 +/- 0.4 kg, P = 0.30) were comparable. However, there was a significant increase in neonatal intensive care unit (NICU) admission and stay for babies born in the insulin group. The cost of treatment was tenfold higher in thethe insulin group.


CONCLUSIONS
Metformin is clinically effective, cheap and a safe alternative to insulin therapy in pregnant diabetic women.
Rai
Lavanya
L
Department of Obstetrics and Gynecology, Kasturba Medical College Hospital, Manipal, Karnataka, India. railavanya@yahoo.com
Meenakshi
D
D
Kamath
Asha
A
D000704:Analysis of Variance; D001786:Blood Glucose; D015992:Body Mass Index; D016001:Confidence Intervals; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy; D016640:Diabetes, Gestational / Q000188:drug therapy*; D005260:Female; D038321:Glycemic Index; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007194:India; D007328:Insulin / Q000627:therapeutic use; D007333:Insulin Resistance; D007363:Intensive Care Units, Neonatal; D007902:Length of Stay; D008687:Metformin / Q000627:therapeutic use*; D011247:Pregnancy; D011446:Prospective Studies
D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin; D008687:Metformin