Comparison between metformin and insulin in treatment of gestational diabetes mellitus and effect on neonatal hypoglycaemia

ABSTRACT

To compare the efficacy of metformin in the treatment of gestational diabetes mellitus [GDM] with insulin and to compare the frequency of hypoglycaemia in neonates of the mothers treated with metformin and insulin. Randomized control trial to compare the efficacy of metformin with insulin in the treatment of GDM. Outpatient department and labour ward of Obstetric and Gynaecology department of Benazir Bhutto Hospital Rawalpindi from August 2012 to January 2013. A total of 110 pregnant ladies with GDM diagnosed after 20 weeks of gestation were included and divided into group A and group B with 55 patients in each group. Group A patients were treated with insulin and group B with metformin. Plasma fasting glucose and two hours postprandial glucose levels were determined on weekly basis for four weeks after starting the treatment to determine the efficacy of insulin and metformin. At birth plasma glucose levels of all the neonates were carried out two hourly, and more frequently depending upon the requirement, during first 24 hours in both the groups to determine neonatal hypoglycaemia. Fasting plasma glucose in group A and B were calculated as 5.96 +/- 0.58 and 5.76 +/- 0.46 mmol/L respectively [p=0.280], while two hours post-prandial plasma glucose levels were 7.34 +/- 0.48 and 7.28 +/- 0.58 mmol/L respectively [p=0.650]. Efficacy in group A was 78.18% and in group B was 70.91% [p=0.381] while frequency of neonatal hypoglycaemia was calculated as 61.54% in group A and 41% in group B [p=0.113]. The efficacy of metformin in treatment of gestational diabetes mellitus is similar as with insulin and the frequency of hypoglycemia in neonates of the mother treated with metformin and insulin is also similar