title: Metformin for the treatment of gestational diabetes: An updated meta-analysis.
abstract: OBJECTIVE
  To assess the efficacy of metformin and insulin in the treatment of pregnant women with gestational diabetes mellitus (GDM).
  
  
  METHODS
  A meta-analysis was conducted by including randomized controlled trials comparing metformin and insulin in GDM. An electronic search was conducted to identify relevant studies. Data were synthesized by a random effects meta-analysis model. A Bayesian analysis was also performed to account for uncertainties in the treatment efficacy.
  
  
  RESULTS
  Eight clinical trials involving 1712 individuals were included in the final analysis. The pooled estimates of metformin-insulin differences were very small and statistically non-significant in fasting plasma glucose, postprandial plasma glucose and HbA1c, measured at 36-37 weeks of gestation. Notably, 14-46% of those receiving metformin required additional insulin. Compared with the insulin group, metformin treatment was associated with a lower incidence of neonatal hypoglycemia (relative risk, RR 0.74; 95% CI 0.58-0.93; P=0.01) and of neonatal intensive care admission (RR 0.76; 95% CI 0.59-0.97; P=0.03). Bayesian analysis revealed that the efficacy of metformin was consistently higher than insulin with a probability of over 98% on these two neonatal complications. Other outcomes were not significantly different between the two treatment groups.
  
  
  CONCLUSIONS
  In women with gestational diabetes, metformin use and insulin therapy have comparable glycemic control profile, but metformin use was associated with lower risk of neonatal hypoglycemia.
authors.affiliation: Social and Administrative Pharmacy Program, Faculty of Pharmaceutical Sciences, Khon Kaen University, Thailand.
authors.forename: Pimprapa
authors.initials: P
authors.lastname: Kitwitee
authors.affiliation: Social and Administrative Pharmacy Program, Faculty of Pharmaceutical Sciences, Khon Kaen University, Thailand.
authors.forename: Supon
authors.initials: S
authors.lastname: Limwattananon
authors.affiliation: Social and Administrative Pharmacy Program, Faculty of Pharmaceutical Sciences, Khon Kaen University, Thailand.
authors.forename: Chulaporn
authors.initials: C
authors.lastname: Limwattananon
authors.affiliation: Clinical Pharmacy Research Unit, Faculty of Pharmacy, Mahasarakham Univeristy, Thailand.
authors.forename: Ornanong
authors.initials: O
authors.lastname: Waleekachonlert
authors.affiliation: Clinical Pharmacy Research Unit, Faculty of Pharmacy, Mahasarakham Univeristy, Thailand.
authors.forename: Tananan
authors.initials: T
authors.lastname: Ratanachotpanich
authors.affiliation: Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine, Chiang Mai University, Thailand.
authors.forename: Mattabhorn
authors.initials: M
authors.lastname: Phimphilai
authors.affiliation: Bone and Mineral Research Program, Garvan Institute of Medical Research, Sydney, Australia.
authors.forename: Tuan V
authors.initials: TV
authors.lastname: Nguyen
authors.affiliation: Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine, Khon Kaen University, Thailand. Electronic address: pchatl@kku.ac.th.
authors.forename: Chatlert
authors.initials: C
authors.lastname: Pongchaiyakul
mesh_terms: D001724:Birth Weight / Q000187:drug effects; D001786:Blood Glucose / Q000187:drug effects / Q000378:metabolism; D016640:Diabetes, Gestational / Q000097:blood / Q000188:drug therapy* / Q000453:epidemiology; D005260:Female; D006801:Humans; D007003:Hypoglycemia / Q000139:chemically induced / Q000453:epidemiology; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007328:Insulin / Q000627:therapeutic use; D008687:Metformin / Q000627:therapeutic use*; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000453:epidemiology; D016896:Treatment Outcome
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin; D008687:Metformin
keywords: Gestational diabetes mellitus; Insulin; Metformin; Oral hypoglycemic agent