الفهرس 
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Abstract
The present study was conducted at Sheikh Zayed Al-nahyan hospital from October 2016 to October 2017. The study included 100 patients, 50 of them were treated by metformin and the other 50 were treated by insulin. The aim of the current study was to evaluate the effectiveness and safety of metformin in treating patients with GDM in Egypt.
Subcutaneous insulin therapy was the standard treatment of women with gestational diabetes not controlled by nutritional therapy and physical activity. However insulin therapy can be difficult for pregnant women due to requirements for multiple injections, risk of hypoglycemia and weight gain.
The rise in insulin resistance is likely to be caused by increasing amounts of hormones related to pregnancy, such as and changes in metabolism to meet the needs of the fetus. However, the entire causes are not clear, whereas normal pregnant women are capable of mounting an increased output of insulin to maintain euglycemia in the face of insulin resistance.
where women with GDM need large amounts of insulin to overcome their insulin resistance. The addition of metformin can reduce insulin needs.
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 second trimester 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.
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 glucose targets.
Analysis of the results revealed that metformin was an effective medication for control of blood glucose in women with GDM who failed to achieve glycemic control 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 to insulin.