title: Metformin versus Insulin in the Management of Pre-Gestational Diabetes Mellitus in Pregnancy and Gestational Diabetes Mellitus at the Korle Bu Teaching Hospital: A Randomized Clinical Trial.
abstract: OBJECTIVE
  To determine if metformin monotherapy or metformin in combination with insulin is equally effective as insulin monotherapy at glycemic control in diabetes mellitus in pregnancy among Ghanaians.
  
  
  METHODS
  This was a study involving 104 pregnant women with type 2 diabetes mellitus (T2DM) or gestational diabetes mellitus (GDM) at 20-30 weeks gestation. Participants were randomized into metformin and insulin treatment groups. Starting dose of metformin was 500 mg once a day and increased gradually over two (2) weeks, to meet glycemic targets. Insulin was added if targets could not be reached on metformin alone at maximum doses. Total daily dose of premixed insulin at initiation was calculated as 0.3 IU/kg body weight and titrated upwards to achieve glycemic control. Glycemic profile monitoring was done every two weeks.
  
  
  RESULTS
  The two hour post prandial blood glucose (2HPG) levels were significantly lower in the metformin group than the insulin group (p= 0.004).
  
  
  CONCLUSIONS
  The findings of this study suggest that metformin monotherapy is effective in achieving glycemic targets in the management of diabetes in pregnancy. It is more effective than insulin in lowering the 2HPG level.
  
  
  BACKGROUND
  Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12614000942651.
authors.affiliation: Department of Obstetrics and Gynecology, Korle Bu Teaching Hospital, Accra, Ghana.
authors.forename: Titus
authors.initials: T
authors.lastname: Beyuo
authors.affiliation: Department of Obstetrics and Gynecology, Korle Bu Teaching Hospital, Accra, Ghana.
authors.forename: Samuel Amenyi
authors.initials: SA
authors.lastname: Obed
authors.affiliation: Department of Medicine and Therapeutics, Korle Bu Teaching Hospital and Department of Pharmacology, University of Ghana Medical School, Accra, Ghana.
authors.forename: Kenneth Kweku
authors.initials: KK
authors.lastname: Adjepong-Yamoah
authors.affiliation: Department of Pharmacology, University of Ghana Medical School, Accra, Ghana.
authors.forename: Kwasi Agyei
authors.initials: KA
authors.lastname: Bugyei
authors.affiliation: Department of Obstetrics and Gynecology, Korle Bu Teaching Hospital, Accra, Ghana.
authors.forename: Samuel Antwi
authors.initials: SA
authors.lastname: Oppong
authors.affiliation: Public Health Unit, Korle Bu Teaching Hospital, Accra, Ghana.
authors.forename: Kissinger
authors.initials: K
authors.lastname: Marfoh
mesh_terms: D000293:Adolescent; D000328:Adult; D001786:Blood Glucose / Q000187:drug effects; D003362:Cost-Benefit Analysis; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy*; D016640:Diabetes, Gestational / Q000188:drug therapy*; D019468:Disease Management; D004359:Drug Therapy, Combination; D005260:Female; D005869:Ghana; D038321:Glycemic Index / Q000187:drug effects; D006784:Hospitals, Teaching; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007328:Insulin / Q000627:therapeutic use*; D008687:Metformin / Q000627:therapeutic use*; D008875:Middle Aged; D011247:Pregnancy; D055815:Young Adult
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin; D008687:Metformin