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Can You Take Metformin For Gestational Diabetes?

Metformin And Insulin For The Treatment Of Gestational Diabetes

Metformin And Insulin For The Treatment Of Gestational Diabetes

Metformin and insulin for the treatment of gestational diabetes Glibenclamide, metformin, and insulin for the treatment of gestational diabetes: a systematic review and meta-analysis BMJ 2015; 350 doi: (Published 21 January 2015) Cite this as: BMJ 2015;350:h102 Metformin and insulin for the treatment of gestational diabetes Gestational diabetes complicates around 5% of pregnancies and its incidence is on rise. Gestational diabetes is associated with increased complications during pregnancy. It is also associated with long-term risk of diabetes in both mother and offspring.1,2 Insulin is used as first line drug in gestational diabetes treatment. Insulin is classified as FDA category B drug means animal reproduction studies have failed to demonstrate a risk to the foetus and there are no adequate and well-controlled studies in pregnant women. FDA approved metformin in year 1994 long after it was approved in many countries for the treatment of type 2 diabetes. Metformin has also been used extensively in patients of infertility with PCOS; as a result many patients continued it inadvertently in first trimester of pregnancy therefore having large safety data in pregnancy. Metformin too categorized as US FDA pregnancy category B, at par with insulin. Recently FDA approved insulin detemir (Levemir, Novo Nordisk) with pregnancy Category B classification. Previously, Levemir was relegated to pregnancy category C, meaning animal reproductive studies has shown an adverse effect on the fetus and adequate and well-controlled studies in humans were not available. FDA changed Levemirs status after receiving a new randomized, controlled trial of 310 pregnant women with type 1 diabetes. The study compared the safety and efficacy of Levemir against NPH insulin. Insulin is a big market wi Continue reading >>

Use Of Metformin In Gestational Diabetes

Use Of Metformin In Gestational Diabetes

Metformin is associated with improved treatment satisfaction and a favorable impact on quality of life (QoL) compared with insulin alone or in combination…. The rise in obesity and the increasing age of mothers have contributed to an increasing incidence of GDM. Depending on the diagnostic criteria used, GDM complicates up to 10% of pregnancies. Treatment conventionally consists of lifestyle measures (diet and physical activity) initially. If target glucose values are not achieved, insulin has traditionally been instituted. Because of the need for constant injections, the risks of hypoglycemia and the potential for weight gain, insulin therapy might be expected to have a negative impact on the QoL for GDM mothers. By contrast, metformin is gaining increasing acceptance as a safe alternative to insulin in the management of GDM. It is associated with improved insulin sensitivity and less maternal weight gain and there is evidence of reduced maternal risk of pre-eclampsia and need for operative delivery. In this study, Latif et al, compare treatment satisfaction and QoL in GDM women receiving metformin alone, insulin alone or a combination of both treatments. One hundred and ninety seven women whose pregnancies had been complicated by GDM were recruited over a 12-month period (2011–2012). Of those, 128 were eligible to be analyzed and 68 patients were treated with metformin alone, 32 with insulin and 28 with the combination of metformin and insulin.Patients had started on insulin as NovoRapid with meals and Insulatard at night if metformin was relatively contra-indicated (renal impairment, history of GI symptoms, inadequate fetal growth on scan) or if this was patient preference. Otherwise, patients were offered metformin initially at a daily dose of 500 mg with meals, Continue reading >>

Metformin For Gestational Diabetes: As Safe And As Effective As Insulin?

Metformin For Gestational Diabetes: As Safe And As Effective As Insulin?

Metformin for gestational diabetes: As safe and as effective as insulin? Rowan JA, Hague WM, Gao W, Battin MR, Moore MP, for the MiG Trial Investigators. Metformin versus insulin for the treatment of gestational diabetes. N Engl J Med. 2008;358:20032015. Professor and Chairman, Department of Obstetrics and Gynecology, Penn State University College of Medicine, and Obstetrician-Gynecologist-in-Chief, Milton S. Hershey Medical Center, Hershey, Pa. Dr. Repke serves on the OBG Management Board of Editors. Compared with insulin, metformin did not increase the risk of perinatal complications and was preferred by most women YES. In this open-label randomized trial comparing metformin, with or without supplemental insulin, with insulin alone, metformin did not increase the risk of perinatal complications and was preferred by a majority of women. Rowan and colleagues add to the data on the potential benefits of oral hypoglycemic agents, compared with insulin, in managing gestational diabetes. The presumption was that dietary treatment alone would not result in adequate glycemic control. In the study, women assigned to metformin were given a starting dosage of 500 mg once or twice daily, which was then increased to a maximum daily dosage of 2,500 mg. According to the authors, women assigned to insulin were prescribed the drug according to usual practice, although that practice was never defined. In addition, if adequate glycemic control was not achieved in the metformin group, insulin was added. Overall, 363 of the women who received metformin completed the study, with 195 receiving metformin alone and 168 ultimately receiving metformin plus insulin. In the other arm, 370 of the women assigned to insulin completed the study. Maternal baseline characteristics were the same for bo Continue reading >>

Brick By Brick: Metformin For Gestational Diabetes Mellitus?

Brick By Brick: Metformin For Gestational Diabetes Mellitus?

Brick by Brick: Metformin for Gestational Diabetes Mellitus? Jean-Luc Ardilouze; Masoud Mahdavian; Jean-Patrice Baillargeon Expert Rev Endocrinol Metab.2010;5(3):353-357. Pregnant women with GDM (defined as 2-h glucose 7.8 mmol/l during a 75-g oral glucose tolerance test [OGTT]) at 28 weeks gestation and not controlled by lifestyle modifications, as demonstrated by self-monitoring of blood glucose (SMBG; 4 tests daily), duly consented to participate in the study and were prescribed metformin. Capillary glucose targets were less than 6.0 mmol/l (fasting) and less than 8.0 mmol/l or under 7.0 mmol/l (1- and 2-h postprandially, respectively). Metformin was titrated: subjects initially received 500 mg twice daily and dosage was adjusted weekly (maximum: 2500 mg daily). Supplementation of metformin by insulin was initiated when glycemic control was not achieved with maximal dosage. Metformin was prescribed to 127 subjects; but the study was not intent-to-treat and 27 women were excluded from analyses: 13 because insulin was required and 14 because of side effects or low compliance. The remaining 100 women, exclusively treated with metformin, were compared with a retrospective cohort of 100 women treated with insulin therapy (a basal-bolus regimen of aspart and glargine). Care was delivered to both groups at the same hospital, by the same team using the same SMBG targets. At baseline, groups were similar in ethnicity (43% Asians and Africans in the metformin group vs 48% in the insulin group), age (34.2 vs 33.9 years), reported pregestational BMI (30.4 vs 30.5 kg/m2), family history of diabetes (50 vs 57% of subjects) and HbA1c at entry (5.5 vs 5.7%); however, subjects in the insulin group reported more previous GDM (13 vs 25%; p = 0.05) and tended to have higher fasting glu Continue reading >>

Women With Gestational Diabetes May Do Best With Metformin And Glyburide Combo

Women With Gestational Diabetes May Do Best With Metformin And Glyburide Combo

A study recently published it the American Diabetes Association’s Diabetes Care journal found that the combination of metformin and glyburide lead to fewer women with gestational diabetes needing insulin after pregnancy when compared to taking just one of the drugs. Researchers sought to find out how effective and safe metformin was compared to glyburide and how well the two worked in a combined treatment for gestational diabetes. Metformin is the first-line treatment for type 2 diabetes which helps increase insulin sensitivity and stops some of the liver’s secretion of glucose. Glyburide is a sulfonylurea which helps to stimulate the increase of insulin in the body. Gestational diabetes is when blood sugar levels rise during pregnancy. Gestational diabetes often leads to type 2 diabetes within the following decade. Researchers conducted a prospective randomized controlled study where they randomly assigned women with gestational diabetes at 13-33 weeks gestation and whose blood sugar levels were inadequately managed by diet to take either metformin or glyburide. If any of the women didn’t have optimal blood sugars, they took the combination of the two drugs. In the case of adverse effects, the women took a different drug and if both didn’t work, then insulin was provided. The researchers looked for the rate of treatment failure and blood sugar management after the first medication was given by checking mean daily blood sugar charts. So Which Medication Worked Best? Glyburide was started in 53 patients. The drug failed in 18 patients due to low blood sugar in 6 patients and a lack of blood sugar control in 12 patients. Metformin was started in 51 patients and failed in 15 patients due to gastrointestinal side effects in one patient a lack of glycemic control in Continue reading >>

Taking Medication And Insulin For Gestational Diabetes

Taking Medication And Insulin For Gestational Diabetes

Depending on the levels of glucose in your blood when you are diagnosed, you may be given the option of reducing your levels through dietary changes and exercise alone. If your levels are still high after a week or two though, you will be offered metformin tablets. If your fasting blood glucose levels are high and you have particular complications such as macrosomia (where the baby is very large) or hydramnios (excessive amniotic fluid), your team may recommend that you start immediate insulin treatment, with or without metformin (as well as dietary and exercise changes). "If I’d understood more about it, I’d have stuck with the diet and found ways to lower my blood glucose levels. Having insulin is not just a quick fix so that you can eat what you want." Kiera, mum of one There are two different types of diabetes medication suitable for women with gestational diabetes: tablets and injection. Tablets - metformin and glibenclamide In pregnancy, there are two types of tablet that you may be offered to help keep your blood glucose at a healthy level: metformin and glibenclamide. Metformin reduces the amount of glucose made by the liver and helps your body respond better to the insulin you produce naturally Glibenclamide lowers blood glucose by stimulating your pancreas to produce more insulin. Like all medication, they carry a risk of side effects, so check the patient information leaflet and talk to your doctor about any possible side effects. Although the patient information leaflet will say that these medications are not to be used during pregnancy, there is strong evidence in the UK for their safety and effectiveness in treating diabetes during pregnancy. Talk to your healthcare team if you have any concerns. Insulin injections If tablets are not suitable for you, Continue reading >>

Metformin In Gestational Diabetes Mellitus

Metformin In Gestational Diabetes Mellitus

Metformin in Gestational Diabetes Mellitus Sara Wilson Reece , PharmD, CDE, BC-ADM, Harish S. Parihar , RPh, PhD, and Christina LoBello Sara Wilson Reece, PharmD, CDE, BC-ADM, is an assistant professor of pharmacy practice; Harish S. Parihar, RPh, PhD, is an assistant professor of pharmaceutical sciences; and Christina LoBello is a doctor of pharmacy candidate in the class of 2015 at the Philadelphia College of Osteopathic Medicine, Georgia Campus, School of Pharmacy, in Suwanee, Ga. Dr. Reece also provides diabetes clinical services for The Longstreet Clinic in Gainesville, Ga. Author information Copyright and License information Disclaimer Copyright 2014 by the American Diabetes Association. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. See for details. As currently diagnosed, gestational diabetes mellitus (GDM) affects 59% of all pregnancies in the United States and is growing in prevalence. 1 It is defined as carbohydrate intolerance of variable severity that is first recognized during pregnancy. Although GDM has been recognized for decades, the potential significance of the condition, as well as criteria for screening and diagnosis, remain debatable. 1 Historically, GDM has been treated with lifestyle modifications and insulin, and oral antihyperglycemic agents have been used infrequently because of concerns regarding neonatal hypoglycemia and teratogenicity. Most recent studies suggest that oral hypoglycemic agents, specifically metformin, are safe to use during pregnancy ( Table 1 ). 2 13 Risk for developing GDM has been noted in women who are overweight before pregnancy, have had GDM in a previous pregnancy, or have a family history of diabetes. Poorer outcomes have be Continue reading >>

Metformin Therapy During Pregnancy

Metformin Therapy During Pregnancy

Type 2 diabetes and gestational diabetes mellitus (GDM) are closely related disorders characterized by increased insulin resistance. Metformin, a biguanide compound, exerts its clinical effect by both reducing hepatic glucose output and by increasing insulin sensitivity. This results in a decreased glucose level without an associated high risk of either hypoglycemia or weight gain. These characteristics have established metformin as an ideal first-line treatment for people with type 2 diabetes and, hypothetically, a particularly attractive drug for use in pregnancy. However, metformin is known to cross the placenta (1,2), and its use in pregnancy has been limited by concerns regarding potential adverse effects on both the mother and the fetus. Historically, some of the earliest reports of the use of metformin during pregnancy have come from South Africa, where it has been used since the late 1970s for women with both type 2 diabetes and GDM (3–6). While perinatal mortality for these women was still higher than that seen in the general obstetric population, it was nonetheless lower than in women who had gone untreated and similar to those who were changed to insulin. No “headline” adverse events or side effects were reported. Confidence regarding the use of metformin in pregnancy has been reinforced by the results of several observational studies and randomized trials over the past decade. Two meta-analyses of observational studies—one of women using metformin and/or sulphonylureas and one of women using metformin alone during the first trimester—did not show an increase in congenital malformations or neonatal deaths (7,8). While increased perinatal mortality and pre-eclampsia was noted in one study of 50 women with type 2 diabetes using metformin, these result Continue reading >>

Gd: Horrific Metformin Side Effects

Gd: Horrific Metformin Side Effects

Diabetes Forum The Global Diabetes Community Find support, ask questions and share your experiences. Join the community Newbie here. Had a browse, thought I'd post. I'm 19w4d and was diagnosed with GD at 17w5d after glycosuria at 16w1d. Midwives and doctors are very concerned as I'm so early on. I haven't been able to control my bloods by diet and exercise at all, and started metformin this past Tuesday at 18w6d. They are expecting to see me again this coming Tuesday at 19w6d to discuss insulin. The problem is, I am utterly miserable on metformin. I started on 500mg in the morning and 500mg at night and was told to gradually increase the dose, going up to 1000mg at night after two days. The first time I took it, I went to bed feeling sick and then got up to use the bathroom and had very loose stools. With every dose I have taken the side effects have got worse. I now can't keep any food down, have true diarrhoea (sorry) to the extent that I've even had an episode of incontinence. I'm utterly miserable and scared to take it. Today I skipped my breakfast dose and of course I feel much better. I'm petrified of taking it, fed up of being so violently sick. Now I know that lots of people experience digestive issues in the beginning and it then settles, so the best thing is to keep on taking it. But my issues are just getting worse. Should I keep taking it anyway? It makes me vomit and I can't eat, and I also won't be able to leave my house if I do. My appointment is in two days on Tuesday, but I'll be able to call them tomorrow. Nobody is there over the weekend. Has this happened to anyone else? What did you do? Metformin caused me the same problems including the incontinence. However I am not pregnant so can only advise you to phone first thing tomorrow and take advice fro Continue reading >>

Metformin In Gestational Diabetes: An Emerging Contender

Metformin In Gestational Diabetes: An Emerging Contender

Metformin in gestational diabetes: An emerging contender 1Consultant Endocrinologist, Department of Endocrinology, G. D Hospital and Diabetes Institute, Kolkata, West Bengal, India 2Chief Endocrinologist, Department of Endocrinology, Sun Valley Diabetes Hospital, Guwahati, Assam, India 1Consultant Endocrinologist, Department of Endocrinology, G. D Hospital and Diabetes Institute, Kolkata, West Bengal, India 2Chief Endocrinologist, Department of Endocrinology, Sun Valley Diabetes Hospital, Guwahati, Assam, India 3Consultant Gynecologist, Department of Gynecology, G. D Hospital and Diabetes Institute, Kolkata, West Bengal, India Corresponding Author: Dr. Awadhesh Kumar Singh, Flat 1C, 3 Canal Street, Kolkata, West Bengal - 700 014, India. E-mail: [email protected]_hgniskard Author information Copyright and License information Disclaimer Copyright : Indian Journal of Endocrinology and Metabolism This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. This article has been cited by other articles in PMC. Gestational diabetes mellitus (GDM) is defined as any degree of glucose intolerance occurring first time during pregnancy. Its prevalence is simultaneously increasing with the global rise of diabesity. GDM commonly develops, when maternal glucose metabolism is unable to compensate for the progressive development of insulin resistance, arising primarily from the consistently rising diabetogenic placental hormones. It classically develops during the second or third trimester. Theoretically, insulin sensitizers should have been the ideal agent in its treatment, given the insulin Continue reading >>

Original Article The Role Of Continuing Metformin Therapy During Pregnancy In The Reduction Of Gestational Diabetes And Improving Pregnancy Outcomes In Women With Polycystic Ovary Syndrome

Original Article The Role Of Continuing Metformin Therapy During Pregnancy In The Reduction Of Gestational Diabetes And Improving Pregnancy Outcomes In Women With Polycystic Ovary Syndrome

Abstract To evaluate the value of continuing metformin therapy in women with PCOS throughout pregnancy and its role in reducing the development of gestational diabetes and improving pregnancy outcome by reducing spontaneous miscarriage rate. Fifty-seven infertile cases with polycystic ovary syndrome who became pregnant were classified into two groups: group 1 included 31 cases who conceived while taking metformin therapy with or without other ovulation inducing agents and continued metformin during pregnancy in a dose of 1000–1500 mg daily and group 2 included 26 cases who conceived without taking metformin and did not take it during pregnancy. Maternal outcome measures including; assessment of insulin resistance, incidence of gestational diabetes mellitus, the need for insulin therapy and incidence of preeclampsia. Fetal outcome measures include incidence of, spontaneous miscarriage, preterm birth, fetal growth abnormalities, suspected fetal asphyxia at birth, fetal anomalies and neonatal mortality. The incidence of gestational diabetes mellitus was significantly lower in cases who received metformin than those who did not receive metformin during pregnancy (3.2% versus 23.08%, respectively), and spontaneous miscarriage occurred in one case (3.2%) in patients who continued metformin compared to 7 cases (26.9%) in patients who did not take metformin. No significant differences between both groups in other outcome measures. Continuous metformin therapy throughout pregnancy in women with PCOS improves pregnancy outcomes by decreasing spontaneous miscarriage rates and prevention of gestational diabetes mellitus with its co morbidity and mortality. Continue reading >>

Metformin For Gestational Diabetes

Metformin For Gestational Diabetes

Since the first trimester I've been having to monitor my glucose level as my OBGYN noticed from the beginning I was 'borderline' for gestational diabetes,therefore taking the glucose test is not on my schedule as I have been monitoring my glucose level since the beginning. The thing is- I am confident that if I were to take the 1 hr/3hr test that everyone takes- that I would pass. Due to recent elevated levels(fasting 95-100), metformin is suggested. I honestly don't think it's medically necessary for me to take it but at the same time, I know gest. diab. Can cause issues with delivery,ect. Has anyone taken Metformjn before during pregnancy and have any insight ?TIA! To be honest I'd ask for a referral to an endocrinologist. Your OB should not be managing any sort of diabetes care unless they have completed a fellowship in maternal fetal medicine. But to be honest only endocrinologist should be the ones managing blood sugars. OBs and PCPs should ask for an opinion from an endo in my opinion. If your fasting levels are high, you have GD, it may not be as bad as some but it's not normal to have a high fasting. I have GD and even my fasting levels are fine unless I eat a bunch of sugar before bed. You can try eating more protein as you bed time snack and make sure you do eat a bed time snack but if that doesn't help then you need medication. Having elevated fasting levels every day is not healthy. It can lead to early labor or even still birth. My friend had to do insulin shots to help her fasting she didn't have any issues with it. I honestly wish I could just take medication. I have pcos and was put on metformin to regulate, everything.. Actually how I got pregnant, I was on 1500 mg a day I will let you know the first day you will feel extremely hung over and dead lol a Continue reading >>

Treatment

Treatment

If you have gestational diabetes, the chances of having problems with the pregnancy can be reduced by controlling your blood sugar (glucose) levels. You'll also need to be more closely monitored during pregnancy and labour to check if treatment is working and to check for any problems. Checking your blood sugar level You'll be given a testing kit that you can use to check your blood sugar level. This involves using a finger-pricking device and putting a drop of blood on a testing strip. You'll be advised: how to test your blood sugar level correctly when and how often to test your blood sugar – most women with gestational diabetes are advised to test before breakfast and one hour after each meal what level you should be aiming for – this will be a measurement given in millimoles of glucose per litre of blood (mmol/l) Diabetes UK has more information about monitoring your glucose levels. Diet Making changes to your diet can help control your blood sugar level. You should be offered a referral to a dietitian, who can give you advice about your diet, and you may be given a leaflet to help you plan your meals. You may be advised to: eat regularly – usually three meals a day – and avoid skipping meals eat starchy and low glycaemic index (GI) foods that release sugar slowly – such as wholewheat pasta, brown rice, granary bread, all-bran cereals, pulses, beans, lentils, muesli and porridge eat plenty of fruit and vegetables – aim for at least five portions a day avoid sugary foods – you don't need a completely sugar-free diet, but try to swap snacks such as cakes and biscuits for healthier alternatives such as fruit, nuts and seeds avoid sugary drinks – sugar-free or diet drinks are better than sugary versions; be aware that fruit juices and smoothies contain s Continue reading >>

Metformin For Gestational Diabetes - What It Is And How It Works

Metformin For Gestational Diabetes - What It Is And How It Works

In the UK it is common to use Metformin for gestational diabetes where dietary and lifestyle changes are not enough to lower and stabilise blood sugar levels. It is widely used to help lower fasting blood sugar levels as well as post meal levels. Metformin is an oral medication in tablet form. It is used in diabetics to help the body use insulin better by increasing how well the insulin works. In pregnancy it can be used in women who have diabetes before becoming pregnant (Type 2 diabetes) and in women who develop diabetes during pregnancy (gestational diabetes). Metformin is also used for other conditions too, commonly used in those that have PCOS (polycystic ovarian syndrome). Metformin is a slow release medication. Here are the most commonly asked Q&A on Metformin for gestational diabetes from our Facebook support group Why do I need to take Metformin? For many ladies with gestational or type 2 diabetes, if lower blood sugar levels cannot be reached through diet and exercise then medication will be required to assist. If blood sugar levels remain high, then the diabetes is not controlled and can cause major complications with the pregnancy and baby. Some consultants will prescribe Metformin on diagnosis of gestational diabetes on the basis of your GTT results. Others will let you try diet control first and when blood glucose levels rise out of target range, or close to the target range, they may prescribe Metformin as a way to help lower and control your levels. NICE guidelines regarding the timing and use of Metformin for gestational diabetes 1.2.19 Offer a trial of changes in diet and exercise to women with gestational diabetes who have a fasting plasma glucose level below 7 mmol/litre at diagnosis. [new 2015] 1.2.20 Offer metformin[4] to women with gestational dia Continue reading >>

Metformin And Pregnancy: Is This Drug Safe?

Metformin And Pregnancy: Is This Drug Safe?

Whether you're expecting your first child or expanding your family, a safe and healthy pregnancy is crucial. This is why you take precautions before and during pregnancy to keep your unborn child healthy and reduce the risk of birth defects. In every pregnancy, there’s a 3 to 5 percent risk of having a baby with a birth defect, according to the Organization of Teratology Information Specialist (OTIS). Some birth defects can’t be prevented. But you can lower your child’s risk by taking prenatal vitamins, maintaining a healthy weight, and maintaining a healthy lifestyle. Your doctor might recommend that you don’t take certain medications while pregnant. This is because certain medications can cause birth defects. If you're taking the prescription drug metformin, you might have concerns about how the drug will affect your pregnancy and the health of your unborn child. What Is Metformin? Metformin is an oral medication used to treat type 2 diabetes and polycystic ovary syndrome (PCOS). Type 2 diabetes is a condition that increases blood sugar levels. PCOS is an endocrine disorder that occurs in women of reproductive age. It’s important to maintain a healthy blood sugar level while pregnant. This is one way to reduce the risk of birth defects and complications. Although metformin can control blood sugar, you may question whether this drug is safe to take during pregnancy. Before we get into this, let’s discuss how metformin is beneficial prior to pregnancy. Metformin Before Conception If you took metformin before getting pregnant, you might know that this drug can be a godsend — especially if you’ve had difficulty conceiving. Having PCOS makes it harder to become pregnant. This condition can cause missed or irregular periods, and small cysts can grow on your Continue reading >>

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