Metformin Better Than Insulin for Gestational Diabetes?

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By: Brenda Neugent

Insulin may not be the best first line of defense for women who develop gestational diabetes, according to the results of a new study.

Research out of São Paulo, Brazil, suggests that for a majority of women who develop diabetes during pregnancy, metformin alone can lower blood glucose and neonatal hypoglycemia rates.

During pregnancy, the same hormones that help the baby develop may cause insulin resistance for the mother, making blood glucose levels rise to dangerous levels and leading to gestational diabetes. It is a particularly high risk for women with polycystic ovary syndrome, who may already have a resistance to insulin.

If treated, all symptoms of diabetes may disappear after birth, though the risk of later developing type 2 diabetes is much higher without lifestyle changes.

But if left untreated, gestational diabetes can lead to high blood glucose levels for both mother and baby, putting both at risk of developing diabetes and other health problems.

Traditionally, women with gestational diabetes have been treated with diet, exercise, and insulin injections, although insulin can cause weight gain beyond the pounds added by pregnancy.

In this new study, women were separated into two groups. One group was given insulin, while the other was given the oral drug metformin. Those who received metformin saw lower glucose levels, less weight gain, and a lower rate of neonatal hypoglycemia. Only 26 percent required supplemental insulin injections in order to bring blood glucose levels to a normal range.

Those who required insulin therapy had developed gestational diabetes earlier in the pregnancy and had higher blood glucose levels than those who did not require insulin.

“We believe that a long-term follow-up is needed, but a discussion by specialist teams on the use of metformin as a first-line drug in the treatment of patients with gestational diabetes would be of great usefulness for patients and doctors,” wrote the authors, which included Dr. Cristiane Pavão Spaulonci and colleagues from the University of São Paulo.

The study appeared in the American Journal of Obstetrics & Gynecology.

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