Metformin, Insulin Show Similar Neonatal Effects

May 7, 2008

The use of metformin in women with gestational diabetes was associated with similar rates of perinatal complications as the use of insulin, according to a report published in the May 8 issue of the New England Journal of Medicine.

WEDNESDAY, May 7 (HealthDay News) -- The use of metformin in women with gestational diabetes was associated with similar rates of perinatal complications as the use of insulin, according to a report published in the May 8 issue of the New England Journal of Medicine.

Janet A. Rowan, of the Auckland City Hospital in Auckland, New Zealand, and colleagues analyzed data from 751 women with gestational diabetes who were randomized between 20 and 33 weeks of gestation to receive insulin or metformin (plus insulin if necessary). The median daily dose of metformin was 2,500 milligrams, and 46.3 percent of women in the metformin group required supplemental insulin.

The rate of a composite outcome including neonatal hypoglycemia, respiratory distress, prematurity, and five-minute Apgar score under 7 was 32 percent in the metformin group and 32.2 percent in the insulin group, the researchers report. Significantly more women in the metformin group would choose their treatment again (76.6 percent versus 27.2 percent).

"The main question now is whether metformin is better or worse than glyburide, an acceptable alternative pill. Although the two oral agents have not been directly compared in trials, it is notable that in [this trial], 46 percent of subjects in the metformin group required supplemental insulin, whereas in the previous trial, only 4 percent of women treated with glyburide needed insulin," write Jeffrey L. Ecker, M.D., and Michael F. Greene, M.D., of Harvard Medical School in Boston, in an accompanying editorial.

One of the study co-authors disclosed a financial relationship with Sanofi-Aventis.

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