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Pregnancy outcomes in pregnant women with diabetes treated with insulin alone and insulin with metformin



Abstract

Aim: The goal of this study was to compare maternal and neonatal results in diabetic pregnant ladies who were treated either insulin and metformin or insulin only.

Methods: 220 pregnant diabetic women with type 1, 2 or gestational diabetes were randomisely assigned into two groups .each group is 110 pregnant diabetic women. One group takes insulin and metformin treatment to achieve glycemic targets and other take insulin only treatment. Pregnancy results in 110 ladies who stayed solely on insulin have been compared to pregnancy results in 110 pregnant diabetic ladies treated with insulin and metformin who were matching for age, weight, as well as ethnicity.

Results: No significant variations in maternal risk factors existed at the start of the study. Group II from enrolling to term, they gained significantly more weight (5.90 vs. 4.39   kg;   P < 0.000). When it came to gestational hypertension, there was no significant difference between groups I and II (14.5 against 19.1%, P = 0.367), pre-eclampsia (7.27 vs. 9.09%, P = 0.622),insulin dosage was decreased in group I statistically significant (mean 39.5±16.5 vs. 55.4±17.5 units, P= 0.000), vaginal delivery (41.8 vs. 47.3%, P = 0.416) or rate of elective Caesarean section (39.1 vs. 32.7%, P = 0.325), rate of emergency caesarean section (19.1 vs. 20%, P=0.865), perinatal loss  (4 cases in group II vs. 3 cases in group I;P=0.701). Group I had a lower rate of neonatal morbidity; prematurity (16.63 vs. 24.55%, P = 0.417), neonatal hypoglycemia (7.3 vs. 24.5 %, P= 0.000), respiratory distress (13.64 vs. 30 %, P= 0.003), neonatal jaundice (13.6 vs. 33.6%, P < 0.000) and admittance to the newborn intensive care unit (24.55 vs. 35.45%, P = 0.077). Macrosomia occurrence (There was a significant difference in birth weight centiles > 90 [group I (16.4%) vs. group II (29.1%); P = 0.024]. The incidence of polyhydramnios was significantly different [group I (13.6%) vs. group II (32.7%); P = 0.001].Shoulder dystocia [group ? (2.7%) vs. group II (4.5%); P=0.721].

Conclusions: Diabetic pregnant women who were treated with insulin plus metformin who had equal baseline risk factors for unfavourable pregnancy outcomes gained less weight and needed less insulin to maintain glycemic control. Furthermore improved neonatal outcomes as macrosomia, neonatal hypoglycemia, respiratory distress and special care baby admission compared with those treated with insulin alone.

 

Keywords: Pregnant Diabetic Women Insulin and Metformin Insulin Maternal Perinatal Outcome

References

  1. Moore TR, Warshark C. Diabetes mellitus and pregnancy. eMedicine. 2010 Jun 1.
  2. Feig DS, Hwee J, Shah BR, Booth GL, Bierman AS, Lipscombe LL. Trends in incidence of diabetes in pregnancy and serious perinatal outcomes: a large, population-based study in Ontario, Canada, 1996–2010. Diabetes care. 2014 Jun 1;37(6):1590-6.
  3. Feig DS, Berger H, Donovan L, Godbout A, Kader T, Keely E, Sanghera R. Erratum to "Diabetes and Pregnancy": Canadian Journal of Diabetes 2018; 42 (S1): S255-S282. Canadian journal of diabetes. 2018 Jun 1;42(3):337.
  4. LAVANYA RAI MD, KAMATH A. Metformin—a convenient alternative to insulin for Indian women with diabetes in pregnancy. Indian J Med Sci. 2009 Nov;63(11).
  5. Lund SS, Tarnow L, Frandsen M, Nielsen BB, Hansen BV, Pedersen O, Parving HH, Vaag AA. Combining insulin with metformin or an insulin secretagogue in non-obese patients with type 2 diabetes: 12 month, randomised, double blind trial. Bmj. 2009 Nov 9;339.
  6. Vella S, Buetow L, Royle P, Livingstone S, Colhoun HM, Petrie JR. The use of metformin in type 1 diabetes: a systematic review of efficacy. Diabetologia. 2010 May;53(5):809-20.
  7. Abdelghaffar S, Attia AM. Metformin added to insulin therapy for type 1 diabetes mellitus in adolescents. Cochrane Database of Systematic Reviews. 2009(1).
  8. Bailey CJ, Bagdonas A, Rubes J, McMorn SO, Donaldson J, Biswas N, Stewart MW. Rosiglitazone/metformin fixed-dose combination compared with uptitrated metformin alone in type 2 diabetes mellitus: a 24-week, multicenter, randomized, double-blind, parallel-group study. Clinical therapeutics. 2005 Oct 1;27(10):1548-61.
  9. Balani J, Hyer SL, Rodin DA, Shehata H. Pregnancy outcomes in women with gestational diabetes treated with metformin or insulin: a case–control study. Diabetic medicine. 2009 Aug;26(8):798-802.
  10. World Health Organization. Diagnostic criteria and classification of hyperglycaemia first detected in pregnancy. World Health Organization; 2013.
  11. American Diabetes Association. Standards of medical care in diabetes—2015 abridged for primary care providers. Clinical diabetes: a publication of the American Diabetes Association. 2015 Apr;33(2):97.
  12. Maymone AC, Baillargeon JP, Menard J, Ardilouze JL. Oral hypoglycemic agents for gestational diabetes mellitus?. Expert opinion on drug safety. 2011 Mar 1;10(2):227-38.
  13. Zhu Y, Olsen SF, Mendola P, Yeung EH, Vaag A, Bowers K, Liu A, Bao W, Li S, Madsen C, Grunnet LG. Growth and obesity through the first 7 y of life in association with levels of maternal glycemia during pregnancy: a prospective cohort study. The American journal of clinical nutrition. 2016 Mar 1;103(3):794-800.
  14. Saleh HS, Abdelsalam WA, Mowafy HE, Abd ElHameid AA. Could metformin manage gestational diabetes mellitus instead of insulin?. International journal of reproductive medicine. 2016 Jan 1;2016.
  15. Waheed S, Malik FP, Mazhar SB. Efficacy of metformin versus insulin in the management of pregnancy with diabetes. J Coll Physicians Surg Pak. 2013 Dec 1;23(12):866-9.
  16. Tertti K, Ekblad U, Vahlberg T, Rönnemaa T. Comparison of metformin and insulin in the treatment of gestational diabetes: a retrospective, case-control study. The review of diabetic studies: RDS. 2008;5(2):95.
  17. Niromanesh S, Alavi A, Sharbaf FR, Amjadi N, Moosavi S, Akbari S. Metformin compared with insulin in the management of gestational diabetes mellitus: a randomized clinical trial. Diabetes research and clinical practice. 2012 Dec 1;98(3):422-9.
  18. Seifarth C, Schehler B, Schneider HJ. Effectiveness of metformin on weight loss in non-diabetic individuals with obesity. Experimental and clinical endocrinology & diabetes. 2013 Jan;121(01):27-31.
  19. D'Ambrosio V, Brunelli R, Vena F, Di Mascio D, Marchetti C, Boccherini C, Piccioni MG, Benedetti Panici P, Giancotti A. Metformin reduces maternal weight gain in obese pregnant women: A systematic review and meta‐analysis of two randomized controlled trials. Diabetes/metabolism research and reviews. 2019 Sep;35(6):e3164.
  20. George A, Mathews JE, Sam D, Beck M, Benjamin SJ, Abraham A, Antonisamy B, Jana AK, Thomas N. Comparison of neonatal outcomes in women with gestational diabetes with moderate hyperglycaemia on metformin or glibenclamide–a randomised controlled trial. Australian and New Zealand journal of obstetrics and gynaecology. 2015 Feb;55(1):47-52.
  21. Mesdaghinia E, Samimi M, Homaei Z, Saberi F, Moosavi SG, Yaribakht M. Comparison of newborn outcomes in women with gestational diabetes mellitus treated with metformin or insulin: a randomised blinded trial. International journal of preventive medicine. 2013 Mar;4(3):327.
  22. 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.
  23. Goh JE, Sadler L, Rowan J. Metformin for gestational diabetes in routine clinical practice. Diabetic Medicine. 2011 Sep;28(9):1082-7.
  24. 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.
  25. Kitwitee P, Limwattananon S, Limwattananon C, Waleekachonlert O, Ratanachotpanich T, Phimphilai M, Nguyen TV, Pongchaiyakul C. Metformin for the treatment of gestational diabetes: an updated meta-analysis. Diabetes research and clinical practice. 2015 Sep 1;109(3):521-32.
  26. 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.
  27. Desai N, Roman A, Rochelson B, Gupta M, Xue X, Chatterjee PK, Tam HT, Metz CN. Maternal metformin treatment decreases fetal inflammation in a rat model of obesity and metabolic syndrome. American journal of obstetrics and gynecology. 2013 Aug 1;209(2):136-e1.
  28. O'Brien TE, Ray JG, Chan WS. Maternal body mass index and the risk of preeclampsia: a systematic overview. Epidemiology. 2003 May 1:368-74.
  29. Xu X, Du C, Zheng Q, Peng L, Sun Y. Effect of metformin on serum interleukin-6 levels in polycystic ovary syndrome: a systematic review. BMC women's health. 2014 Dec;14(1):1-7.
  30. Parchim NF, Wang W, Iriyama T, Ashimi OA, Siddiqui AH, Blackwell S, Sibai B, Kellems RE, Xia Y. Neurokinin 3 receptor and phosphocholine transferase: missing factors for pathogenesis of C-reactive protein in preeclampsia. Hypertension. 2015 Feb;65(2):430-9.
  31. Romero R, Erez O, Hüttemann M, Maymon E, Panaitescu B, Conde-Agudelo A, Pacora P, Yoon BH, Grossman LI. Metformin, the aspirin of the 21st century: its role in gestational diabetes mellitus, prevention of preeclampsia and cancer, and the promotion of longevity. American journal of obstetrics and gynecology. 2017 Sep 1;217(3):282-302.
  32. Lucas MJ, Leveno KJ, Williams ML, Raskin P, Whalley PJ. Early pregnancy glycosylated hemoglobin, severity of diabetes, and fetal malformations. American journal of obstetrics and gynecology. 1989 Aug 1;161(2):426-31.
  33. Moore LE, Briery CM, Clokey D, Martin RW, Williford NJ, Bofill JA, Morrison JC. Metformin and insulin in the management of gestational diabetes mellitus: preliminary results of a comparison. The Journal of reproductive medicine. 2007 Nov 1;52(11):1011-5.
  34. 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.
  35. Rowan JA. A trial in progress: gestational diabetes: treatment with metformin compared with insulin (the Metformin in Gestational Diabetes [MiG] trial). Diabetes care. 2007 Jul 1;30(Supplement 2):S214-9.

How to Cite

Elsaeed, U. A., Reda Ismail Riad, Ahmed Taher, Mahmoud Elnokeety, & Sherif Elanwary. (2022). Pregnancy outcomes in pregnant women with diabetes treated with insulin alone and insulin with metformin. Bali Medical Journal, 11(3), 1234–1242. https://doi.org/10.15562/bmj.v11i3.3082
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Usama Ahmed Elsaeed
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Reda Ismail Riad
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Ahmed Taher
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Mahmoud Elnokeety
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Sherif Elanwary
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