The efficacy of metformin compared with insulin

in regulating blood glucose levels during

gestational diabetes mellitus: A randomized
clinical trial
Nayereh Ghomian, Seyede Houra Mousavi, Vahed Samaneh Firouz, Mohammad Ali Yaghoubi ,
Masoud Mohebbi,Amirhossein Sahebkar.

Andhika Kusuma Hamdany

DR.Dr. Fabiola.M.S. Adam,SpPD KEMD

DIVISION ENDOCRINOLOGY, METABOLISM, AND DIABETES

 Introduction
Gestational diabetes mellitus (GDM) is among the most frequent and
most serious complications following pregnancy (American Diabetes
Association). The incidence of gestational diabetes in the United States
is about 7% (about 200,000 in four million births), and in 90% of these
women, glucose intolerance resolves after pregnancy.

Fetal and neonatal complication of GDM including intrauterine fetal

demise, congenital anomaly, fetal macrosomia, birth traumas,
hypoglycemia, hyperbilirubinemia, respiratory distress,
cardiomyopathy, hypocalcemia, prematurity, and pulmonary hyaline
membrane disease

Maternal short‐term complications of GDM include increased chance of

cesarean section, hyperglycemia crisis, urinary tract infections, and
preeclampsia. Moreover, long‐term complications include
predisposition to developing type 2 diabetes as well as cardiovascular
disorders such as hyperlipidemia and hypertension
 Introduction
Medical nutrition therapy (MNT) is the standard
supportive approach applied to all women suffering from
GDM, which can relieve both pregnancy and neonatal
complications .

Insulin has been a conventional medication in the treatment

of female patients suffering from gestational diabetes
mellitus (GDM). However, the need for a large number of
insulin injections in these patients causes them a lot of
discomforts.

Recently, an alternative medication, metformin, has received

considerable attention in the treatment of GDM
MATERIALS AND METHODS
The inclusion criteria were
pregnant women aged between The exclusion criteria
18 and 40 with a gestational age were refusal for
over 24 weeks diagnosed with
GDM, singleton pregnancy, attendance in
failure to achieve glycemic follow‐up sessions
control with exercise and diet
during 1 week, absence of overt for any reason and
diabetes mellitus, absence of not responding to
lactic acidosis risk factor,
absence of fetal anomaly, 1500 mg of
absence of medical diseases in metformin.
mothers such as kidney or liver
diseases, and filling the
informed consent for
participation in the study.
Demographic Profile
Results
RESULTS
 DISCUSSION
Evaluation concerned with the diagnosis of GDM commence during
pregnancy, and in case GDM is established, the mother and her
child should remain under medical monitoring for several years
following deliverydue complication such as diabetes as well as
other possible pathologies.

These studies have indicated the similar effect of metformin

and insulin on reducing FPG. While reporting on the similar
effect of the two medications, some researchers have
mentioned the need for supplementary insulin in a few
patients when FPG could not be adequately controlled.

As for evaluation performed during pregnancy concerning

glycosylated hemoglobin, the findings indicated equal levels
of HbA1c in both metformin and insulin groups, with no
statistically significant difference.
 DISCUSSION
• As for the rate of cesarean section, the current study compared the
corresponding incidence index between the two groups and found no
statistically significant differences. Likewise, a randomized controlled trial
conducted in 2016 revealed no statistically significant differences between the
metformin and insulin groups in terms of the number of cesarean section
cases .

• Concerning the incidence rate of birth trauma, the current study detected no
statistically significant difference between the two groups. Another study,
involving 363 patients in the metformin group, did not find any significant
difference between the two groups.

• Concerning the occurrence of neonatal hypoglycemia, the available literature has

reported different results as far as the two GDM treatment methods were concerned
(Kitwitee et al., 10; Rowan et al., 20; Tertti et al., 25; Zhu et al., 30). Rowan et al. (20)
compared two groups of subjects (insulin vs. metformin) and observed a decreased
incidence rate of severe hypoglycemia in the metformin group, which represented a
statistically significant difference.
 CONCLUSION
• In the current study, data related to fasting
glucose levels, HbA1c levels, and 2-hr PG did not
indicate any statistically significant difference
between the two treatment groups (metformin
vs. insulin).
• Therefore due to certain advantages of
metformin—being more convenient to use and
requiring no injections—it can be recommended
as a favorable substitute for insulin in the
treatment of GDM
THANK YOU