The efficacy and safety of metformin alone or as an add-on therapy to insulin in pregnancy with GDM or T2DM
Main Article Content
Keywords
Gestational diabetes mellitus (GDM), Metformin, type 2 diabetes mellitus (T2DM), Insulin
Abstract
Because it is inexpensive, safe, and can be taken orally, metformin has lately attracted a lot of attention and acceptability for treatment in GDM. The FDA presently lists it as a category B medication for usage during pregnancy.
Objectives: to evaluate the safety and effectiveness of metformin either on its own or in combination with insulin for pregnant women with GDM or T2DM.
Materials and methods: We did a thorough search of Cochrane Library, Embase, and PubMed. Text and medical topic headings such as metformin, insulin, gestational diabetes, pregnancy, and gestational diabetes mellitus were utilized in the search. To find other relevant RCTs, we additionally looked through the references in a few chosen publications and reviews as well as ClinicalTrials.gov.
Results, and Conclusion: Unlike insulin, metformin may help expectant mothers and their unborn children without raising the risk of specific results for the mother and the fetus.
References
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11. Ainuddin JA, Karim N, Zaheer S, et al. Metformin treatment in type 2 diabetes in pregnancy: an active controlled, parallel-group, randomized, open label study in patients with type 2 diabetes in pregnancy. J Diabetes Res. 2015; 2015: 325851
12. Ashoush S, El‐Said M, Fathi H, Abdelnaby M. Identification of metformin poor responders, requiring supplemental insulin, during randomization of metformin versus insulin for the control of gestational diabetes mellitus. Journal of Obstetrics and Gynaecology Research. 2016 Jun;42(6):640-7.
13. Ghomian N, Vahed SH, Firouz S, Yaghoubi MA, Mohebbi M, Sahebkar A. The efficacy of metformin compared with insulin in regulating blood glucose levels during gestational diabetes mellitus: a randomized clinical trial. Journal of cellular physiology. 2019 Apr;234(4):4695-701.
14. Ijäs H, Vääräsmäki M, Morin‐Papunen L, Keravuo R, Ebeling T, Saarela T, Raudaskoski T. Metformin should be considered in the treatment of gestational diabetes: a prospective randomised study. BJOG: An International Journal of Obstetrics & Gynaecology. 2011 Jun;118(7):880-5.
15. Rowan JA, Hague WM, Gao W, Battin MR, Moore MP. Metformin versus insulin for the treatment of gestational diabetes. New England Journal of Medicine. 2008 May 8;358(19):2003-15.
16. Feig DS, Donovan LE, Zinman B, Sanchez JJ, Asztalos E, Ryan EA, Fantus IG, Hutton E, Armson AB, Lipscombe LL, Simmons D. Metformin in women with type 2 diabetes in pregnancy (MiTy): a multicentre, international, randomised, placebo-controlled trial. The Lancet Diabetes & Endocrinology. 2020 Oct 1;8(10):834-44.
17. Spaulonci CP, Bernardes LS, Trindade TC, Zugaib M, Francisco RP. Randomized trial of metformin vs insulin in the management of gestational diabetes. American journal of obstetrics and gynecology. 2013 Jul 1;209(1):34-e1.
18. Coustan DR, Lowe LP, Metzger BE, Dyer AR. The Hyperglycemia and Adverse Pregnancy Outcome (HAPO) study: paving the way for new diagnostic criteria for gestational diabetes mellitus. Am J Obstet Gynecol 2010;202:654.e1-6.
19. Langer O, Yogev Y, Most O, Xenakis EM. Gestational diabetes: the consequences of not treating. Am J Obstet Gynecol 2005;192: 989-97.
20. Moore LE, Clokey D, Rappaport VJ, Curet LB. Metformin compared with glyburide in gestational diabetes: a randomized controlled trial. Obstetrics & Gynecology. 2010 Jan 1;115(1):55-9.
21. Nicholson W, Bolen S, Witkop CT, Neale D, Wilson L, Bass E. Benefits and risks of oral diabetes agents compared with insulin in women with gestational diabetes: a systematic review. Obstet Gynecol 2009;113:193-205
22. Wensel TM. Role of metformin in the treatment of gestational diabetes. Ann Pharmacother 2009;43:939-43. 8. Cheung NW. The management of gestational diabetes. Vasc Health Risk Manag 2009;5: 153-64.
23. Silva JC, Pacheco C, Bizato J, de Souza BV, Ribeiro TE, Bertini AM. Metformin compared with glyburide for the management of gestational diabetes. Int J Gynaecol Obstet 2010; 111: 37-40. 10. Dhulkotia JS, Ola B, Fraser R, Farrell T. Oral hypoglycemic agents vs insulin in management of gestational diabetes: a systematic review and metaanalysis. Am J Obstet Gynecol 2010;203: 457.e1-9.
24. Bao LX, Shi WT, Han YX. Metformin versus insulin for gestational diabetes: a systematic review and meta-analysis. J Matern Fetal Neonatal Med. 2021; 34(16): 2741-2753.
25. Guo L, Ma J, Tang J, Hu D, Zhang W, Zhao X. Comparative efficacy and safety of metformin, glyburide, and insulin in treating gestational diabetes mellitus: a meta-analysis. Journal of diabetes research. 2019 Nov 4;2019.
26. Tarry-Adkins JL, Ozanne SE, Aiken CE. Impact of metformin treatment during pregnancy on maternal outcomes: a systematic review/meta-analysis. Sci Rep. 2021; 11(1): 9240.
27. Wang X, Liu W, Chen H, Chen Q. Comparison of insulin, metformin, and glyburide on perinatal complications of gestational diabetes mellitus: a systematic review and meta-analysis. Gynecologic and Obstetric Investigation. 2021 May 12;86(3):218-30.
2. DeSisto CL, Kim SY, Sharma AJ. Prevalence estimates of gestational diabetes mellitus in the United States, Pregnancy Risk Assessment Monitoring System (PRAMS), 2007–2010. Prev Chronic Dis. 2014;11:E104.
3. Zhu Y, Zhang C. Prevalence of gestational diabetes and risk of progression to type 2 diabetes: a global perspective. Curr Diab Rep. 2016;16(1):7.
4. HAPO Study Cooperative Research Group. Hyperglycemia and Adverse Pregnancy Outcome (HAPO) Study: associations with neonatal anthropometrics. Diabetes. 2009 Feb 1;58(2):453-9.
5. Bellamy L, Casas JP, Hingorani AD, Williams D. Type 2 diabetes mellitus after gestational diabetes: a systematic review and meta-analysis. The Lancet. 2009 May 23;373(9677):1773-9.
6. Chiefari E, Arcidiacono B, Foti D, Brunetti A. Gestational diabetes mellitus: an updated overview. Journal of endocrinological investigation. 2017 Sep;40:899-909.
7. Metzger BE. Long-term outcomes in mothers diagnosed with gestational diabetes mellitus and their offspring. Clin Obstet Gynecol. 2007;50(4):972–979.
8. Pirkola J, Pouta A, Bloigu A, Hartikainen AL, Laitinen J, Järvelin MR, Vääräsmäki M. Risks of overweight and abdominal obesity at age 16 years associated with prenatal exposures to maternal prepregnancy overweight and gestational diabetes mellitus. Diabetes care. 2010 May 1;33(5):1115-21.
9. Simmons D. Metformin treatment for type 2 diabetes in pregnancy? Best Pract Res Clin Endocrinol Metab. 2010;24(4):625–634.
10. Bergman JE, Lutke LR, Gans RO, Addor MC, Barisic I, Cavero-Carbonell C, Garne E, Gatt M, Klungsoyr K, Lelong N, Lynch C. Beta-blocker use in pregnancy and risk of specific congenital anomalies: a European case-malformed control study. Drug safety. 2018 Apr;41:415-27.
11. Ainuddin JA, Karim N, Zaheer S, et al. Metformin treatment in type 2 diabetes in pregnancy: an active controlled, parallel-group, randomized, open label study in patients with type 2 diabetes in pregnancy. J Diabetes Res. 2015; 2015: 325851
12. Ashoush S, El‐Said M, Fathi H, Abdelnaby M. Identification of metformin poor responders, requiring supplemental insulin, during randomization of metformin versus insulin for the control of gestational diabetes mellitus. Journal of Obstetrics and Gynaecology Research. 2016 Jun;42(6):640-7.
13. Ghomian N, Vahed SH, Firouz S, Yaghoubi MA, Mohebbi M, Sahebkar A. The efficacy of metformin compared with insulin in regulating blood glucose levels during gestational diabetes mellitus: a randomized clinical trial. Journal of cellular physiology. 2019 Apr;234(4):4695-701.
14. Ijäs H, Vääräsmäki M, Morin‐Papunen L, Keravuo R, Ebeling T, Saarela T, Raudaskoski T. Metformin should be considered in the treatment of gestational diabetes: a prospective randomised study. BJOG: An International Journal of Obstetrics & Gynaecology. 2011 Jun;118(7):880-5.
15. Rowan JA, Hague WM, Gao W, Battin MR, Moore MP. Metformin versus insulin for the treatment of gestational diabetes. New England Journal of Medicine. 2008 May 8;358(19):2003-15.
16. Feig DS, Donovan LE, Zinman B, Sanchez JJ, Asztalos E, Ryan EA, Fantus IG, Hutton E, Armson AB, Lipscombe LL, Simmons D. Metformin in women with type 2 diabetes in pregnancy (MiTy): a multicentre, international, randomised, placebo-controlled trial. The Lancet Diabetes & Endocrinology. 2020 Oct 1;8(10):834-44.
17. Spaulonci CP, Bernardes LS, Trindade TC, Zugaib M, Francisco RP. Randomized trial of metformin vs insulin in the management of gestational diabetes. American journal of obstetrics and gynecology. 2013 Jul 1;209(1):34-e1.
18. Coustan DR, Lowe LP, Metzger BE, Dyer AR. The Hyperglycemia and Adverse Pregnancy Outcome (HAPO) study: paving the way for new diagnostic criteria for gestational diabetes mellitus. Am J Obstet Gynecol 2010;202:654.e1-6.
19. Langer O, Yogev Y, Most O, Xenakis EM. Gestational diabetes: the consequences of not treating. Am J Obstet Gynecol 2005;192: 989-97.
20. Moore LE, Clokey D, Rappaport VJ, Curet LB. Metformin compared with glyburide in gestational diabetes: a randomized controlled trial. Obstetrics & Gynecology. 2010 Jan 1;115(1):55-9.
21. Nicholson W, Bolen S, Witkop CT, Neale D, Wilson L, Bass E. Benefits and risks of oral diabetes agents compared with insulin in women with gestational diabetes: a systematic review. Obstet Gynecol 2009;113:193-205
22. Wensel TM. Role of metformin in the treatment of gestational diabetes. Ann Pharmacother 2009;43:939-43. 8. Cheung NW. The management of gestational diabetes. Vasc Health Risk Manag 2009;5: 153-64.
23. Silva JC, Pacheco C, Bizato J, de Souza BV, Ribeiro TE, Bertini AM. Metformin compared with glyburide for the management of gestational diabetes. Int J Gynaecol Obstet 2010; 111: 37-40. 10. Dhulkotia JS, Ola B, Fraser R, Farrell T. Oral hypoglycemic agents vs insulin in management of gestational diabetes: a systematic review and metaanalysis. Am J Obstet Gynecol 2010;203: 457.e1-9.
24. Bao LX, Shi WT, Han YX. Metformin versus insulin for gestational diabetes: a systematic review and meta-analysis. J Matern Fetal Neonatal Med. 2021; 34(16): 2741-2753.
25. Guo L, Ma J, Tang J, Hu D, Zhang W, Zhao X. Comparative efficacy and safety of metformin, glyburide, and insulin in treating gestational diabetes mellitus: a meta-analysis. Journal of diabetes research. 2019 Nov 4;2019.
26. Tarry-Adkins JL, Ozanne SE, Aiken CE. Impact of metformin treatment during pregnancy on maternal outcomes: a systematic review/meta-analysis. Sci Rep. 2021; 11(1): 9240.
27. Wang X, Liu W, Chen H, Chen Q. Comparison of insulin, metformin, and glyburide on perinatal complications of gestational diabetes mellitus: a systematic review and meta-analysis. Gynecologic and Obstetric Investigation. 2021 May 12;86(3):218-30.
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Published
May 20, 2022
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How to Cite
Mohammed Ali Juman Alghamdi1, Ayman Ibrahim Dahlan1, Adnan Hameed Alharbi1, Hashim Kassim Eissa1, Alghamdi, Amro Ali S2, Faisal Zowid Almutairi3, Turki Hassan Alamri3, Fawaz Zowid Almutairi4. (2022). The efficacy and safety of metformin alone or as an add-on therapy to insulin in pregnancy with GDM or T2DM. Journal of Population Therapeutics and Clinical Pharmacology, 29(04), 1214-1218. https://doi.org/10.53555/jptcp.v29i04.5714
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All articles published in JPTCP are licensed under Copyright Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
Mohammed Ali Juman Alghamdi1, Ayman Ibrahim Dahlan1, Adnan Hameed Alharbi1, Hashim Kassim Eissa1, Alghamdi, Amro Ali S2, Faisal Zowid Almutairi3, Turki Hassan Alamri3, Fawaz Zowid Almutairi4. (2022). The efficacy and safety of metformin alone or as an add-on therapy to insulin in pregnancy with GDM or T2DM. Journal of Population Therapeutics and Clinical Pharmacology, 29(04), 1214-1218. https://doi.org/10.53555/jptcp.v29i04.5714