Metformin versus insulin for gestational diabetes mellitus: a meta-analysis.
The aim of the present meta-analysis was to determine the efficacy and safety of metformin for the treatment of women with gestational diabetes mellitus (GDM). We searched databases, including PubMed, Embase and the Cochrane Central Register of Controlled Trials, for randomized controlled trials (RCTs) comparing metformin and insulin treatments in women with GDM. We carried out statistical analyses using RevMan 2011 and used the Grading of Recommendations, Assessment, Development, and Evaluations profiler to rate the quality of evidence of the primary outcomes. We analysed eight studies involving 1592 subjects. Meta-analysis of the RCTs showed that metformin had statistically significant effects on pregnancy-induced hypertension [PIH; risk ratio (RR) 0.54; 95% confidence interval (CI) 0.31, 0.91]. However, its effects on neonatal hypoglycaemia (RR 0.80; 95% CI 0.62, 1.02), rate of large-for-gestational age infants (RR 0.77; 95% CI 0.55, 1.08), respiratory distress syndrome (RR 1.26; 95% CI 0.67, 2.37), phototherapy (RR 0.94; 95% CI 0.67, 1.31) and perinatal death (RR 1.01; 95% CI 0.11, 9.53) were not significant. Our analyses suggest that there is no clinically relevant difference in efficacy or safety between metformin and insulin; however, metformin may be a good choice for GDM because of the lower risk of PIH. The advantages of metformin in terms of glycaemic control, PIH incidence and gestational age at birth are unclear, and should be verified in further trials.
Department of Pharmacy, Peking University First Hospital, Beijing, China.|Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University Health Science Center, Beijing, China.
Li-Ping
LP
Zhao
Department of Pharmacy, Peking University First Hospital, Beijing, China.
Xiao-Yan
XY
Sheng
Department of Pharmacy, Peking University First Hospital, Beijing, China.|Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University Health Science Center, Beijing, China.
Shuang
S
Zhou
Department of Pharmacy, Peking University First Hospital, Beijing, China.
Ting
T
Yang
Department of Pharmacy, Peking University First Hospital, Beijing, China.
Ling-Yue
LY
Ma
Department of Pharmacy, Peking University First Hospital, Beijing, China.|Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University Health Science Center, Beijing, China.
Ying
Y
Zhou
Department of Pharmacy, Peking University First Hospital, Beijing, China.|Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University Health Science Center, Beijing, China.
Yi-Min
YM
Cui
D016640:Diabetes, Gestational / Q000188:drug therapy*; D005260:Female; D006801:Humans; D046110:Hypertension, Pregnancy-Induced / Q000188:drug therapy; D007328:Insulin / Q000627:therapeutic use*; D008687:Metformin / Q000009:adverse effects* / Q000627:therapeutic use*; D011247:Pregnancy; D016032:Randomized Controlled Trials as Topic
D007328:Insulin; D008687:Metformin
gestational diabetes; insulin; metformin; randomized controlled trial