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 >>
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 >>
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 >>
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 >>
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 >>
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 >>
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 >>
Drugs For Gestational Diabetes
Aust Prescr 2010;33:141-41 Oct 2010DOI: 10.18773/austprescr.2010.066 The prevalence of gestational diabetes is increasing in Australia. Non-pharmacological intervention with dietary measures and exercise is the mainstay of therapy in most cases, but insulin is increasingly necessary to achieve adequate glycaemic control in some women. Basal-bolus insulin is the optimal management strategy, but therapy needs to be individualised. Although there is mounting evidence for the efficacy and safety of metformin, the lack of long-term follow-up data has prevented it from being recommended by most experts in the field. Women with gestational diabetes need long-term follow-up because of their increased risk of type 2 diabetes. Gestational diabetes is defined as an intolerance to glucose that is first diagnosed or has its onset during pregnancy. It is estimated to affect almost 5% of pregnancies in Australia and between 3% and 9% worldwide. Its prevalence increases with age, from 1% in women aged 1519 years to 13% in those aged 4449 years. 1 Other risk factors for developing gestational diabetes include being overweight or obese, having a family history of type 2 diabetes or a personal or family history of gestational diabetes or glucose intolerance, being from an Aboriginal or Torres Strait Islander background or belonging to certain ethnic groups (for example Polynesian, Middle Eastern, Indian or other Asian origin). 2 Although gestational diabetes does not affect perinatal mortality, it does increase morbidity, including the risk of shoulder dystocia, nerve palsies and neonatal hypoglycaemia. Maternal outcomes are also affected, with a higher incidence of pre-eclampsia and caesarean section (particularly with poor glycaemic control) in mothers who develop gestational diabetes. Continue reading >>
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 >>
Metformin & Pregnancy
Diabetes Forum The Global Diabetes Community Find support, ask questions and share your experiences. Join the community Hi everyone. I hope you will be able to help me. Last week, I got diagnosed with Gestational Diabetes. This is my fourth pregnancy. I got GD in my second pregnancy but not in the other 2. The first time round, I controlled it by diet alone with no problems. My baby was 7lbs 12ozs which was absolutely fine. This time, after my GTT, my levels were quite high. The Diabetic Midwife put me on a strict diet straight away and after a few days contacted me to say they were still too high and that I needed to go on Metformin. I am not that happy about this as every website I have been on has said that these tablets shouldn't be taken in pregnancy. I'm at a loss with what to do now. I'm almost 40 and this is my last child and I'm concerned taking these tablets will cause problems for the baby. I spoke to a Pharmacist about these tablets and he couldn't help either. I would be grateful if anyone could advise me on these tablets and what the possible side effects for the baby are and whether or not they are indeed safe. From my own reading into this subject, Metformin has been shown to improve Insulin sensitivity and may also help with weight loss. Apparently it does cross the placenta but but trials have shown no (serious) adverse effects. In one study in 2007 (MiG 2007) it was suggested that Metformin was safe to use and that there was no evidence of any increase in complications and/or birth defects. It was approved by NICE for use in pregnant Diabetic Women. If you are concerned then this is something you should discuss more fully with your Diabetic Midwife. You are obviously under enough stress without adding more. There have been some posts here about this Continue reading >>
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 - 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 to women with gestational dia Continue reading >>
Is It Safe To Use Metformin During Pregnancy?
Metformin is a commonly used drug for managing type 2 diabetes. It is considered an effective treatment option for many people with diabetes, but is it safe for pregnant women? Metformin is a drug that helps to lower blood sugar. It is considered one of the best first line treatments for type 2 diabetes. A review posted to Diabetology & Metabolic Syndrome notes that metformin helps to lower blood sugar levels, strengthens the endocrine system, improves insulin resistance, and reduces fat distribution in the body. Before taking any drugs, including metformin, a pregnant woman has to be absolutely sure that the drugs will not affect her or her baby. Effects of metformin use during and after pregnancy Some people are concerned about using metformin during and after pregnancy because it crosses the placenta. This means that when a pregnant woman takes metformin, so does her baby. However, the results of the few studies that have been carried out so far into the effects of taking metformin during pregnancy have been positive. A 2014 review posted to Human Reproduction Update found that the drug did not cause birth defects, complications, or diseases. The researchers did note, however, that larger studies should be carried out to make this evidence more conclusive. Metformin and gestational diabetes A separate review posted to Human Reproduction Update noted that women who took metformin to treat gestational diabetes (diabetes during pregnancy) gained less weight than women who took insulin. A 2-year follow-up study found that babies born to the women treated with metformin had less fat around their organs, which could make them less prone to insulin resistance later in life. This could mean that children who are exposed to metformin at a young age could gain long-term benefi Continue reading >>
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 >>
Metformin For The Treatment Of Gestational Diabetes: An Updated Meta-analysis.
Metformin for the treatment of gestational diabetes: An updated meta-analysis. Social and Administrative Pharmacy Program, Faculty of Pharmaceutical Sciences, Khon Kaen University, Thailand. Clinical Pharmacy Research Unit, Faculty of Pharmacy, Mahasarakham Univeristy, Thailand. Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine, Chiang Mai University, Thailand. Bone and Mineral Research Program, Garvan Institute of Medical Research, Sydney, Australia. Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine, Khon Kaen University, Thailand. Electronic address: [email protected] Diabetes Res Clin Pract. 2015 Sep;109(3):521-32. doi: 10.1016/j.diabres.2015.05.017. Epub 2015 May 14. OBJECTIVE: To assess the efficacy of metformin and insulin in the treatment of pregnant women with gestational diabetes mellitus (GDM). METHODS: A meta-analysis was conducted by including randomized controlled trials comparing metformin and insulin in GDM. An electronic search was conducted to identify relevant studies. Data were synthesized by a random effects meta-analysis model. A Bayesian analysis was also performed to account for uncertainties in the treatment efficacy. RESULTS: Eight clinical trials involving 1712 individuals were included in the final analysis. The pooled estimates of metformin-insulin differences were very small and statistically non-significant in fasting plasma glucose, postprandial plasma glucose and HbA1c, measured at 36-37 weeks of gestation. Notably, 14-46% of those receiving metformin required additional insulin. Compared with the insulin group, metformin treatment was associated with a lower incidence of neonatal hypoglycemia (relative risk, RR 0.74; 95% CI 0.58-0.93; P=0.01) and of neonatal intensi Continue reading >>