Metformin versus insulin for the treatment of gestational diabetes

Rowan, Janet A., Hague, William M., Gao, Wanzhen, Battin, Malcolm R., Moore, M. Peter, McIntyre, Harold D. and MiG Trial Investigators (2008) Metformin versus insulin for the treatment of gestational diabetes. The New England Journal of Medicine, 358 19: 2003-2015. doi:10.1056/NEJMoa0707193


Author Rowan, Janet A.
Hague, William M.
Gao, Wanzhen
Battin, Malcolm R.
Moore, M. Peter
McIntyre, Harold D.
MiG Trial Investigators
Title Metformin versus insulin for the treatment of gestational diabetes
Journal name The New England Journal of Medicine   Check publisher's open access policy
ISSN 1533-4406
0028-4793
Publication date 2008-05-08
Sub-type Article (original research)
DOI 10.1056/NEJMoa0707193
Volume 358
Issue 19
Start page 2003
End page 2015
Total pages 13
Place of publication Boston, U.S.A.
Publisher Massachusetts Medical Society
Language eng
Subject 110306 Endocrinology
11 Medical and Health Sciences
Formatted abstract
Background
Metformin is a logical treatment for women with gestational diabetes mellitus, but randomized trials to assess the efficacy and safety of its use for this condition are lacking.

Methods
We randomly assigned 751 women with gestational diabetes mellitus at 20 to 33 weeks of gestation to open treatment with metformin (with supplemental insulin if required) or insulin. The primary outcome was a composite of neonatal hypoglycemia, respiratory distress, need for phototherapy, birth trauma, 5-minute Apgar score less than 7, or prematurity. The trial was designed to rule out a 33% increase (from 30% to 40%) in this composite outcome in infants of women treated with metformin as compared with those treated with insulin. Secondary outcomes included neonatal anthropometric measurements, maternal glycemic control, maternal hypertensive complications, postpartum glucose tolerance, and acceptability of treatment.

Results
Of the 363 women assigned to metformin, 92.6% continued to receive metformin until delivery and 46.3% received supplemental insulin. The rate of the primary composite outcome was 32.0% in the group assigned to metformin and 32.2% in the insulin group (relative risk, 0.99; 95% confidence interval, 0.80 to 1.23). More women in the metformin group than in the insulin group stated that they would choose to receive their assigned treatment again (76.6% vs. 27.2%, P<0.001). The rates of other secondary outcomes did not differ significantly between the groups. There were no serious adverse events associated with the use of metformin.

Conclusions

In women with gestational diabetes mellitus, metformin (alone or with supplemental insulin) is not associated with increased perinatal complications as compared with insulin. The women preferred metformin to insulin treatment. (Australian New Zealand Clinical Trials Registry number, 12605000311651.)


Keyword Polycystic-ovary-syndrome
Pregnancy outcomes
Birth-weight
Mellitus
Glyburide
Mothers
Women
Trimester
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status Non-UQ

Document type: Journal Article
Sub-type: Article (original research)
Collection: School of Medicine Publications
 
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Created: Fri, 16 Oct 2009, 11:25:26 EST by Ms Lynette Adams on behalf of Faculty Of Health Sciences