Randomized trial of metformin vs insulin in the management of gestational diabetes
Abstract
Objective To evaluate glycemic control in women receiving metformin or insulin for gestational diabetes, and to identify factors predicting the need for supplemental insulin in women initially treated with metformin.Study design Women with gestational diabetes who failed to achieve glycemic control with diet and exercise were randomized to receive metformin (n = 47) or insulin (n = 47). Criteria for inclusion were singleton pregnancy, diet, and exercise for a minimum period of 1 week without satisfactory glycemic control, absence of risk factors for lactic acidosis, and absence of anatomic and/or chromosome anomalies of the conceptus. Patients who were lost to prenatal follow-up were excluded.Results Comparison of mean pretreatment glucose levels showed no significant difference between groups (P = .790). After introduction of the drug, lower mean glucose levels were observed in the metformin group (P = .020), mainly because of lower levels after dinner (P = .042). Women using metformin presented less weight gain (P = .002) and a lower frequency of neonatal hypoglycemia (P = .032). Twelve women in the metformin group (26.08%) required supplemental insulin for glycemic control. Early gestational age at diagnosis (odds ratio, 0.71; 95% confidence interval, 0.52-0.97; P = .032) and mean pretreatment glucose level (odds ratio, 1.061; 95% confidence interval, 1.001-1.124; P = .046) were identified as predictors of the need for insulin.Conclusion Metformin was found to provide adequate glycemic control with lower mean glucose levels throughout the day, less weight gain and a lower frequency of neonatal hypoglycemia. Logistic regression analysis showed that gestational age at diagnosis and mean pretreatment glucose level were predictors of the need for supplemental insulin therapy in women initially treated with metformin.
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The rate of hypoglycemia is lower than that reported with insulin.
“The rate of hypoglycemia is lower than that reported with insulin(79).”
From Metformin, the Aspirin of the 21st Century: Its Role in Gestational Diabetes Mellitus, Prevention of Preeclampsia and Cancer, and the Promotion of Longevity (2017) · cites this paper as [79]
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- Authors
- Spaulonci, C. P., Bernardes, L. S., Trindade, T. C., Zugaib, M., & Francisco, R. P. V.
- Affiliations
- Universidade de São Paulo (BR)
- ORCID
- Venue
- American Journal of Obstetrics and Gynecology
- Publisher
- Elsevier BV
- Published
- 2013-07
- Volume
- 209
- Issue
- 1
- Pages
- 34.e1-34.e7
- ISSN
- 0002-9378 (ISSN-L)
- OpenAlex
- W1992355896
- Cited by
- 183
- References
- 23
- Citations by year
- 2026: 4 · 2025: 10 · 2024: 11 · 2023: 16 · 2022: 8 · 2021: 17 · 2020: 10 · 2019: 18 · 2018: 20 · 2017: 15 · 2016: 17 · 2015: 16 · 2014: 17 · 2013: 4
- FWCI
- 20.15
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- American Journal of Obstetrics and Gynecology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Obstetrics and Gynecology › Gestational Diabetes Research and Management
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Pregnancy and Medication Impact
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Keywords
- gestational diabetes mellitus, metformin, insulin therapy, glycemic control, neonatal hypoglycemia, gestational weight gain, gestational age at diagnosis
- MeSH terms
- Blood Glucose, Brazil, Female, Gestational Age, Humans, Hypoglycemic Agents, Insulin, Metformin, Pregnancy, Weight Gain, Logistic Models, Diabetes, Gestational
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