Effects of metformin and insulin therapy regimens on postpartum oral glucose tolerance test results in pregnant women with gestational diabetes mellitus: a comparative study
-
Moghadaseh Jahanshahi
und
Shoreh Vosough
Abstract
Objectives
The main purpose of this study was to compare the effects of two regimens of metformin and insulin therapy on postpartum oral glucose tolerance test (OGTT) results in pregnant women with gestational diabetes mellitus (GDM).
Methods
In this single-blind randomized clinical trial (RCT), a total number of 60 pregnant women meeting the inclusion criteria were assigned to two groups with a randomized block design (RBD): insulin therapy (IT) group (30 patients) and metformin therapy (MT) group (30 patients). At baseline, the data were comprised of prenatal maternal age, gestational age, GDM diagnosis, and maternal weight/height. During the postpartum period, 5-cc blood samples were taken from the pregnant women concerned to analyze their fasting blood sugar (FBS) levels. Then, the patients were asked to come back four days and six weeks later after delivery to check the OGTT results. At six weeks postpartum, in addition to OGTT, the glycated hemoglobin (HbA1C) test was performed for all mothers. Finally, six weeks after delivery, these mothers were evaluated with regard to weight loss and body mass index (BMI).
Results
Six weeks postpartum, the maternal weight and BMI significantly decreased in the MT group compared with the IT one, while there was no significant difference between both groups at baseline. On the fourth day, the OGTT results in the MT group were significantly lower in comparison with those in the IT group (p=0.012). At sixth weeks postpartum, the OGTT results were comparably lower in the MT group than those reported for the IT one; however, such a difference was not statistically significant (p=0.087).
Conclusions
According to the study results, metformin could be an effective and safe treatment for pregnant women suffering from GDM instead of insulin therapy.
Research funding: None declared.
Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.
Competing interests: None declared.
Informed consent: Informed written consent was obtained from the subjects to participate in the study.
Ethical approval: Research involving human subjects complied with all relevant national regulations, institutional policies and is in accordance with the tenets of the Helsinki Declaration (as revised in 2013), and has been approved by the authors’ Institutional Review Board (IR.Gomus.REC.1397.028) or equivalent committee.
References
1. Katon, J, Reiber, G, Williams, MA, Yanez, D, Miller, E. Hemoglobin A1c and postpartum abnormal glucose tolerance among women with gestational diabetes. Obstet Gynecol 2012;119:566. https://doi.org/10.1097/aog.0b013e3182475ac2.10.1097/AOG.0b013e3182475ac2Suche in Google Scholar PubMed PubMed Central
2. Carson, MP, Frank, MI, Keely, E. Original research: postpartum testing rates among women with a history of gestational diabetes—systematic review. Prim Care Diabetes 2013;7:177–86. https://doi.org/10.1016/j.pcd.2013.04.007.10.1016/j.pcd.2013.04.007Suche in Google Scholar PubMed
3. Göbl, CS, Bozkurt, L, Prikoszovich, T, Tura, A, Pacini, G, Kautzky-Willer, A. Estimating the risk after gestational diabetes mellitus: can we improve the information from the postpartum OGTT? Am J Physiol-Endocrinol Metabol 2013;304:E524–30. https://doi.org/10.1152/ajpendo.00461.2012.10.1152/ajpendo.00461.2012Suche in Google Scholar PubMed
4. Ko, JY, Dietz, PM, Conrey, EJ, Rodgers, LE, Shellhaas, C, Farr, SL, et al.. Strategies associated with higher postpartum glucose tolerance screening rates for gestational diabetes mellitus patients. J Wom Health 2013;22:681–6. https://doi.org/10.1089/jwh.2012.4092.10.1089/jwh.2012.4092Suche in Google Scholar PubMed PubMed Central
5. Assessment of quality of life and treatment satisfaction with metformin and insulin inGestational diabetes. In: Latif, L, Hyer, S, Shehata, H, editors. BJOG-An International Journal of Obstetrics and Gynaecology. USA: Wiley-Blackwell; 2013. 111 River St, Hoboken 07030-5774, NJ.Suche in Google Scholar
6. Capula, C, Chiefari, E, Vero, A, Foti, DP, Brunetti, A, Vero, R. Prevalence and predictors of postpartum glucose intolerance in Italian women with gestational diabetes mellitus. Diabetes Res Clin Pract 2014;105:223–30. https://doi.org/10.1016/j.diabres.2014.05.008.10.1016/j.diabres.2014.05.008Suche in Google Scholar PubMed
7. Chen, Z, Watanabe, RM, Stram, DO, Buchanan, TA, Xiang, AH. High calorie intake is associated with worsening insulin resistance and β-cell function in hispanic women after gestational diabetes mellitus. Diabetes Care 2014;37:3294–300. https://doi.org/10.2337/dc14-1433.10.2337/dc14-1433Suche in Google Scholar PubMed PubMed Central
8. Kramer, CK, Swaminathan, B, Hanley, AJ, Connelly, PW, Sermer, M, Zinman, B, et al.. Each degree of glucose intolerance in pregnancy predicts distinct trajectories of β-cell function, insulin sensitivity, and glycemia in the first 3 years postpartum. Diabetes Care 2014;37:3262–9. https://doi.org/10.2337/dc14-1529.10.2337/dc14-1529Suche in Google Scholar PubMed
9. Marques, P, Carvalho, M, Pinto, L, Guerra, S. Metformin safety in the management of gestational diabetes. Endocr Pract 2014;20:1022–31. https://doi.org/10.4158/ep14018.or.10.4158/EP14018.ORSuche in Google Scholar PubMed
10. Nielsen, KK, Kapur, A, Damm, P, De Courten, M, Bygbjerg, IC. From screening to postpartum follow-up–the determinants and barriers for gestational diabetes mellitus (GDM) services, a systematic review. BMC Pregnancy Childbirth 2014;14:1. https://doi.org/10.1186/1471-2393-14-41.10.1186/1471-2393-14-41Suche in Google Scholar PubMed PubMed Central
11. Sukumaran, S, Madhuvrata, P, Bustani, R, Song, S, Farrel, TA. Screening, diagnosis and management of gestational diabetes mellitus: a national survey. Obstet Med 2014;7:111–5. https://doi.org/10.1177/1753495X14536891.10.1177/1753495X14536891Suche in Google Scholar PubMed PubMed Central
12. Ainuddin, JA, Kazi, S, Aftab, S, Kamran, A. Metformin for preventing gestational diabetes in women with polycystic ovarian syndrome. J Coll Phys Surg Pakistan: JCPSP 2015;25:237–41. https://doi.org/10.04.2015/JCPSP.237241.Suche in Google Scholar
13. Kelley, KW, Carroll, DG, Meyer, A. A review of current treatment strategies for gestational diabetes mellitus. Drugs Context 2015;4. https://doi.org/10.7573/dic.212282.10.7573/dic.212282Suche in Google Scholar PubMed PubMed Central
14. Leuridan, L, Wens, J, Devlieger, R, Verhaeghe, J, Mathieu, C, Benhalima, K. Glucose intolerance in early postpartum in women with gestational diabetes: who is at increasedrisk? Prim Care Diabetes 2015;9:244–52. https://doi.org/10.1016/j.pcd.2015.03.007.10.1016/j.pcd.2015.03.007Suche in Google Scholar PubMed
15. Kojima, N, Tanimura, K, Deguchi, M, Morizane, M, Hirota, Y, Ogawa, W, et al.. Risk factors for postpartum glucose intolerance in women with gestational diabetes mellitus. Gynecol Endocrinol 2016;32:803–6. https://doi.org/10.1080/09513590.2016.1177009.10.1080/09513590.2016.1177009Suche in Google Scholar PubMed
16. Kugishima, Y, Yasuhi, I, Yamashita, H, Fukuda, M, Kuzume, A, Sugimi, S, et al.. Risk factors associated with abnormal glucose tolerance in the early postpartum period among Japanese women with gestational diabetes. Int J Gynecol Obstet 2015;129:42–5. https://doi.org/10.1016/j.ijgo.2014.09.030.10.1016/j.ijgo.2014.09.030Suche in Google Scholar PubMed
17. Webber, J, Charlton, M, Johns, N. Diabetes in pregnancy: management of diabetes and its complications from preconception to the postnatal period (NG3). Br J Diabetes Vasc Dis 2015;15:107–11. https://doi.org/10.15277/bjdvd.2015.029.10.15277/bjdvd.2015.029Suche in Google Scholar
18. Wei, J, Li, X, Gao, J. Insulin secretion and tolerance of women with different gestational glucose regulation one year postpartum. Int J Clin Exp Med 2015;8:6384.Suche in Google Scholar
19. Pellonperä, O, Rönnemaa, T, Ekblad, U, Vahlberg, T, Tertti, K. The effects of metformin treatment of gestational diabetes on maternal weight and glucose tolerance postpartum–a prospective follow‐up study. Acta Obstet Gynecol Scand 2016;95:79–87. https://doi.org/10.1111/aogs.12788.10.1111/aogs.12788Suche in Google Scholar PubMed
20. Bansal, N, Chaudhary, P, Ramola, M, Saxena, N. Comparison of metformin and insulin in the treatment of gestational diabetes: a retrospective study. Int J Reprod Contracept Obstet Gynecol 2016;5:4356–60. https://doi.org/10.18203/2320-1770.ijrcog20164342.10.18203/2320-1770.ijrcog20164342Suche in Google Scholar
21. Tang, T, Glanville, J, Hayden, CJ, White, D, Barth, JH, Balen, AH. Combined lifestyle modification and metformin in obese patients with polycystic ovary syndrome. A randomized, placebo-controlled, double-blind multicentre study. Hum Reprod 2006;21:80–9. https://doi.org/10.1093/humrep/dei311.10.1093/humrep/dei311Suche in Google Scholar PubMed
22. Werner, EF, Has, P, Tarabulsi, G, Lee, J, Satin, A. Early postpartum glucose testing in women with gestational diabetes mellitus. Am J Perinatol 2016;71:697–9.10.1097/01.ogx.0000510809.66411.87Suche in Google Scholar
23. Spaulonci, CP, Bernardes, LS, Trindade, TC, Zugaib, M, Francisco, RP. Randomized trial of metformin vs insulin in the management of gestational diabetes. Am J Obstet Gynecol 2013;209:34–e1. https://doi.org/10.1016/j.ajog.2013.03.022.10.1016/j.ajog.2013.03.022Suche in Google Scholar PubMed
24. Niromanesh, S, Alavi, A, Rahimi Sharbaf, F, Amjadi, N, Moosavi, S, Akbari, S. Metformin compared with insulin in the management of gestational diabetes mellitus: a randomized clinical trial. Diabetes Res Clin Pract 2012;98:422–9. https://doi.org/10.1016/j.diabres.2012.09.031.10.1016/j.diabres.2012.09.031Suche in Google Scholar PubMed
25. Saleh, HS, Abdelsalam, WA, Mowafy, HE, Abd ElHameid, AA. Could metformin manage gestational diabetes mellitus instead of insulin? Hindawi Publishing Corporation. Int J Reprod Med 2016; 3480629:8.10.1155/2016/3480629Suche in Google Scholar PubMed PubMed Central
© 2020 Walter de Gruyter GmbH, Berlin/Boston
Artikel in diesem Heft
- Letter to the Editor
- Evidence-based medicine is a valuable tool for a successful decision-making on risk-reducing bilateral mastectomy
- Original Articles
- Melatonin inhibits high glucose-induced ox-LDL/LDL expression and apoptosis in human umbilical endothelial cells
- Effects of metformin and insulin therapy regimens on postpartum oral glucose tolerance test results in pregnant women with gestational diabetes mellitus: a comparative study
- Association of IL-33 gene rs16924159 polymorphism and recurrent pregnancy loss in Iranian Azeri women
- Greater effects of high- compared with moderate-intensity interval training on thyroid hormones in overweight/obese adolescent girls
- Effect of Artemisia absinthium ethanolic extract on oxidative stress markers and the TLR4, S100A4, Bax and Bcl-2 genes expression in the kidney of STZ-induced diabetic rats
- Associations of endothelial biomarkers, nitric oxide metabolites and endothelin, with blood pressure and coronary lesions depend on cardiovascular risk and sex to mark endothelial dysfunction on the SCORE scale
- Association of nitric oxide synthase 3 gene rs1799983 G/T polymorphism with idiopathic asthenozoospermia in Iranian Azeri males: a case-control study
- Adiponectin and leptin levels in normal weight women with polycystic ovary syndrome
- Review Articles
- Association between vitamin D deficiency and prevalence of metabolic syndrome in female population: a systematic review
- Vitamin D and sleep duration: Is there a bidirectional relationship?
- Challenges of post-traumatic stress disorder (PTSD) in Iraq: biochemical network and methodologies. A brief review
- Female urine incontinence: vaginal erbium laser (VEL) effectiveness and safety
- Breast cancer risk factors in Iran: a systematic review & meta-analysis
- Effects of melatonin supplementation on oxidative stress: a systematic review and meta-analysis of randomized controlled trials
Artikel in diesem Heft
- Letter to the Editor
- Evidence-based medicine is a valuable tool for a successful decision-making on risk-reducing bilateral mastectomy
- Original Articles
- Melatonin inhibits high glucose-induced ox-LDL/LDL expression and apoptosis in human umbilical endothelial cells
- Effects of metformin and insulin therapy regimens on postpartum oral glucose tolerance test results in pregnant women with gestational diabetes mellitus: a comparative study
- Association of IL-33 gene rs16924159 polymorphism and recurrent pregnancy loss in Iranian Azeri women
- Greater effects of high- compared with moderate-intensity interval training on thyroid hormones in overweight/obese adolescent girls
- Effect of Artemisia absinthium ethanolic extract on oxidative stress markers and the TLR4, S100A4, Bax and Bcl-2 genes expression in the kidney of STZ-induced diabetic rats
- Associations of endothelial biomarkers, nitric oxide metabolites and endothelin, with blood pressure and coronary lesions depend on cardiovascular risk and sex to mark endothelial dysfunction on the SCORE scale
- Association of nitric oxide synthase 3 gene rs1799983 G/T polymorphism with idiopathic asthenozoospermia in Iranian Azeri males: a case-control study
- Adiponectin and leptin levels in normal weight women with polycystic ovary syndrome
- Review Articles
- Association between vitamin D deficiency and prevalence of metabolic syndrome in female population: a systematic review
- Vitamin D and sleep duration: Is there a bidirectional relationship?
- Challenges of post-traumatic stress disorder (PTSD) in Iraq: biochemical network and methodologies. A brief review
- Female urine incontinence: vaginal erbium laser (VEL) effectiveness and safety
- Breast cancer risk factors in Iran: a systematic review & meta-analysis
- Effects of melatonin supplementation on oxidative stress: a systematic review and meta-analysis of randomized controlled trials
