Metformin is as good as insulin for glycemic control and improving neonatal outcomes in women with gestational diabetes mellitus (GDM).
Gestational diabetes mellitus (GDM) is defined in the World Health Organization guidelines as glucose intolerance or hyperglycemia that occurs or is first recognized during pregnancy. Owing to changes in lifestyle and increasing maternal age, the prevalence of GDM has increased markedly during the past two decades, with prevalences of between 1 and 26% being recorded in different studies.
Appropriate glycemic control is the principal means of preventing hyperinsulinemia and macrosomia [14]. As the conventional treatment for GDM, insulin is effective and safe. However, it is inconvenient and expensive to use. During the last 20 years, oral hypoglycemic agents (OHAs) have been introduced for GDM, of which the most frequently used drugs are glyburide and metformin. Glyburide is a second-generation sulfonylurea that binds to receptors on beta-cells and increases the secretion of insulin [15]. Metformin is a biguanide that increases insulin-stimulated glucose uptake in muscle cells and suppresses gluconeogenesis and fatty acid oxidation in hepatocytes
A team of researchers from China conducted a study to assess the comparative efficiency and safety of the use of glyburide, metformin, and insulin in gestational diabetes mellitus (GDM).
The researchers searched for randomized controlled trials that compared glyburide, metformin, and insulin in GDM. Data regarding glycemic control and neonatal safety were collected and analyzed in pairwise and network meta-analyses.
The results of the study are as follows:
A total of 4533 individuals from 23 trials were included.
Compared with glyburide, metformin reduced 2-h postprandial blood glucose (2HPG) to a greater extent
There was a significantly lower prevalence of neonatal hypoglycemia and preeclampsia in the metformin group than in the insulin group.
The metformin group had significantly lower birth weight and maternal weight gain compared with the insulin group.
Network meta-analysis suggested that metformin had the highest probability of successfully controlling glycemia and preventing neonatal complications.
Thus, the researchers concluded that the present meta-analysis suggests that metformin may be as effective as insulin for glycemic control and is the most promising drug for the prevention of neonatal and maternal complications.
Reference:
A study titled, "Glycemic control and neonatal outcomes in women with gestational diabetes mellitus treated using glyburide, metformin, or insulin: a pairwise and network meta-analysis" by Dan-Qing Yu et al. published in the BMC Endocrine Disorders.
https://doi.org/10.1186/s12902-021-00865-9