Effect of adding Metformin to Insulin therapy in the third trimester of pregnant women with uncontrolled type I Diabetes as regard pregnancy outcome
Abdallah, A., Hamed, D., AM Eweis, M. (2023). Effect of adding Metformin to Insulin therapy in the third trimester of pregnant women with uncontrolled type I Diabetes as regard pregnancy outcome. EKB Journal Management System, 4(2), 104-116. doi: 10.21608/ejmr.2022.117314.1184
Amal Kotb Abdallah; Doaa Hamdy Hamed; Mohammed AM Eweis. "Effect of adding Metformin to Insulin therapy in the third trimester of pregnant women with uncontrolled type I Diabetes as regard pregnancy outcome". EKB Journal Management System, 4, 2, 2023, 104-116. doi: 10.21608/ejmr.2022.117314.1184
Abdallah, A., Hamed, D., AM Eweis, M. (2023). 'Effect of adding Metformin to Insulin therapy in the third trimester of pregnant women with uncontrolled type I Diabetes as regard pregnancy outcome', EKB Journal Management System, 4(2), pp. 104-116. doi: 10.21608/ejmr.2022.117314.1184
Abdallah, A., Hamed, D., AM Eweis, M. Effect of adding Metformin to Insulin therapy in the third trimester of pregnant women with uncontrolled type I Diabetes as regard pregnancy outcome. EKB Journal Management System, 2023; 4(2): 104-116. doi: 10.21608/ejmr.2022.117314.1184

Effect of adding Metformin to Insulin therapy in the third trimester of pregnant women with uncontrolled type I Diabetes as regard pregnancy outcome

Egyptian Journal of Medical Research
Volume 4, Issue 2, April 2023, Page 104-116  XML PDF (513.25 K)
Document Type: Original Article
DOI: 10.21608/ejmr.2022.117314.1184
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Authors
Amal Kotb Abdallah; Doaa Hamdy Hamed email ; Mohammed AM Eweis
Obstetrics and Gynecology department, Faculty of Medicine, Beni-Suef University, Egypt
Abstract
Objective: To examine if addition of metformin to insulin is an effective alternative to insulin alone, to lower insulin dose, hospital stay, maternal and neonatal complications in pregnant women at third trimester with uncontrolled type I Diabetes Mellitus, particularly in a resource-poor setting.  Material and method: Our randomized controlled trial included 80 patients, who were distributed into two equal groups; group A treated with metformin and insulin and group B treated with insulin alone, in Beni-suef and Cairo University hospitals. Results: We found that metformin and insulin group (Group A) showed significant outcomes regarding shortened hospital stay, lower insulin dose and lower maternal weight gain during pregnancy (p values: 0.04, 0.02 and 0.03 respectively). Most of maternal and neonatal complications were non-significantly lower in group A. Conclusion: Oral metformin therapy is an effective and safe additional treatment option for diabetic women with type I diabetes during pregnancy to lower insulin requirements, hospital stay and most maternal and fetal complications, especially in settings with limited economic resources.
Keywords
Type I Diabetes Mellitus; GDM; Metformin in pregnancy; Third trimester maternal and neonatal complications
References
  1. American Diabetes Association. Standards of medical care in diabetes—2010. Diabetes care. 2010 Jan 1;33(Supplement 1):S11-61.
  2. Committee on Practice Bulletins—Obstetrics. Practice bulletin no. 137: gestational diabetes mellitus. Obstet Gynecol. 2013 Aug; 122(2 Pt 1):406-16.
  3. Falavigna M, Schmidt MI, Trujillo J, Alves LF, Wendland ER, Torloni MR, Colagiuri S, Duncan BB. Effectiveness of gestational diabetes treatment: a systematic review with quality of evidence assessment. Diabetes research and clinical practice. 2012 Dec 1;98(3):396-405.
  4. Kelley KW, Carroll DG, Meyer A. A review of current treatment strategies for gestational diabetes mellitus. Drugs in context. 2015;4.
  5. Feng L, Lin XF, Wan ZH, Hu D, Du YK. Efficacy of metformin on pregnancy complications in women with polycystic ovary syndrome: a meta-analysis. Gynecological Endocrinology. 2015 Nov 2;31(11):833-9.
  6. Tan X, Li S, Chang Y, Fang C, Liu H, Zhang X, Wang Y. Effect of metformin treatment during pregnancy on women with PCOS: a systematic review and meta-analysis. Clinical and Investigative Medicine. 2016 Sep 11:E120-31.
  7. Feng YE, Yang H. Metformin–a potentially effective drug for gestational diabetes mellitus: a systematic review and meta-analysis. The Journal of Maternal-Fetal & Neonatal Medicine. 2017 Aug 3;30(15):1874-81.
  8. Farrar D, Simmonds M, Bryant M, Sheldon TA, Tuffnell D, Golder S, Lawlor DA. Treatments for gestational diabetes: a systematic review and meta-analysis. BMJ open. 2017 Jun 1;7(6).
  9. Priya G, Kalra S. Metformin in the management of diabetes during pregnancy and lactation. Drugs in context. 2018;7.
  10. Brown J. Oral anti-diabetic pharmacological therapies for the treatment of women with gestational diabetes [Internet]. Cochrane Database of Systematic Reviews, Oxford, CD011967. 2017.
  11. Liang HL, Ma SJ, Xiao YN, Tan HZ. Comparative efficacy and safety of oral antidiabetic drugs and insulin in treating gestational diabetes mellitus: an updated PRISMA-compliant network meta-analysis. Medicine. 2017 Sep;96(38)..
  12. Caughey AB, Turrentine M. Gestational diabetes mellitus. Obstetrics and Gynecology. 2018 Feb 1;131(2):E49-64.
  13. Le-xin Bao, Wan-ting Shi, Yu-xin Han. Metformin versus insulin for gestational diabetes: a systematic review and meta-analysis, The Journal of Maternal-Fetal & Neonatal Medicine, 2019, DOI: 1080/14767058.2019.1670804
  14. Dickens LT, Thomas CC. Updates in gestational diabetes prevalence, treatment, and health policy. Current diabetes reports. 2019 Jun 1;19(6):33.
  15. Singh N, Madhu M, Vanamail P, Malik N, Kumar S. Efficacy of metformin in improving glycaemic control & perinatal outcome in gestational diabetes mellitus: a non-randomized study. The Indian journal of medical research. 2017 May;145(5):623.
  16. American College of Obstetricians and Gynecologists (ACOG): Gestational diabetes mellitus. Practice, Bulletin No. 180, July 2017a.
  17. Pridjian G, Benjamin TD. Update on gestational diabetes. Obstetrics and Gynecology Clinics. 2010 Jun 1;37(2):255-67.
  18. DeFronzo RA. Pharmacologic therapy for type 2 diabetes mellitus. Annals of internal medicine. 1999 Aug 17;131(4):281-303.
  19. Nicolaou V, Soepnel L, Huddle KR, Levitt N, Klipstein-Grobusch K, Norris SA. Maternal and neonatal outcomes following the introduction of oral hypoglycaemic agents for gestational diabetes mellitus were comparable to insulin monotherapy in two historical cohorts. SAMJ: South African Medical Journal. 2020 Feb;110(2):154-8.
  20. Sibai BM, Caritis SN, Hauth JC, MacPherson C, VanDorsten JP, Klebanoff M, Landon M, Paul RH, Meis PJ, Miodovnik M, Dombrowski MP. Preterm delivery in women with pregestational diabetes mellitus or chronic hypertension relative to women with uncomplicated pregnancies. American journal of obstetrics and gynecology. 2000 Dec 1;183(6):1520-4.
  21. Reece EA, Eriksson UJ. Congenital malformations: epidemiology, pathogenesis, and experimental methods of induction and prevention. Diabetes in Women: Adolescent, Pregnancy, and Menopause. Lippincott Williams & Wilkins, Philadelphia. 2004:169-204.
  22. Vargas R, Repke JT, Ural SH. Type 1 diabetes mellitus and pregnancy. Reviews in obstetrics and gynecology. 2010;3(3):92.
  23. Mariam L, Abeer BA, Hassan A, Rasha EK, Mahmoud A. Assessment of Metformin Versus Insulin for the Treatment of Gestational Diabetes. The Medical Journal of Cairo University. 2019 Jun 10;87(June):2385-92.
  24. Rowan JA, Hague WM, Gao W, Battin MR, Moore MP. Metformin versus insulin for the treatment of gestational diabetes. New England Journal of Medicine. 2008 May 8;358(19):2003-15.
  25. Niromanesh S, Alavi A, Sharbaf FR, Amjadi N, Moosavi S, Akbari S. Metformin compared with insulin in the management of gestational diabetes mellitus: a randomized clinical trial. Diabetes research and clinical practice. 2012 Dec 1;98(3):422-9.
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