الفهرس | Only 14 pages are availabe for public view |
Abstract The use of antidiabetic drugs to control gestational diabetes was controversial. Some studies suggest a possible link between the use of oral antidiadetics and fetal anomalies, fetal macrosomia and neonatal hypoglycemia whereas others have demonstrated no such relationship. Metformin is a biguanide hypoglycemic agent that reduces hepatic gluconeogenesis and increases peripheral insulin sensitivity. Although it crosses placenta, metformin appear to be safe in pregnancy. Many studies have suggested the potential safety of this drug in pregnancy and its ability to maintain adequate glycemic control. In the present study, the aim was to compare the efficacy of metformin with that of insulin in treatment of gestational diabetes mellitus. The present study included 100 pregnant women who have been diagnosed as gestational diabetics at 25-33 weeks gestation with singleton pregnancy. They had FBG level ranging from 95-120 mg/ dl or 2-hour postprandial blood glucose level ranging from 120-190 mg/dl. The exclusion criteria include pregnant women with preexisting DM and underlying diseases known to affect fetal growth or drug clearance. All patients were randomized to receive metformin (n=50) or insulin (n=50). All patients were followed up during their antenatal visits in outpatient clinic. The HbA1C was measured before the initiation of therapy. During each visit, fasting and 2 hrs blood glucose level were assessed every week. Metformin was started at an oral dose of 500mg tablet taken daily with the evening meal; after a week, the dose is increased to 500 mg twice daily, with the morning and evening meals. Assuming this dose is tolerated, 1 week later, the dose is further increased to 500 mg three times daily, with tablets taken with the morning, midday, and evening meals. Further increases were occasionally needed, to total daily doses of 2000-2500 mg daily, in divided doses with meals. Comparison of the baseline characteristics was performed between 2 groups and there were no significant differences between the two groups regarding maternal age, gravidity, parity, GA at time of diagnosis, GA at beginning of treatment, and BMI at time of diagnosis Additionally, it was noticed that women in the metformin treated group reached sooner to the glucosetargets and maternal weight gain was less in the metformin treated group. About 23.4% of women in the metformin treated group required supplemental insulin to achieve adequate glucose level; it was found that women who required supplemental insulin had higher BMI, earlier gestational age at the start of treatment and higher levels of FBG and 2 hrs glucose level at time of diagnosis. Analysis of the results revealed that metformin was an effective medication for control of blood glucose in women with GDM who failed to achieve euglycemic with diet only. The time for metformin as an alternative treatment to insulin has come; however, it should be prescribed after careful consideration of these patient characteristics to minimize the need for supplemental insulin. |