Feto-maternal outcomes and Glycemic control in Metformin versus insulin treated Gestational Diabetics

Objective: To evaluate and compare feto-maternal outcomes and glycemic control in metformin versus insulin treated gestational diabetics. Methods: The study was conducted in 2010-2012 as a part of M. Phil at Civil hospital, Lyari General Hospital and Mamji Hospital in Karachi. After written informed consent, 71 GDM diagnosed females with WHO criteria were enrolled. They were divided into two groups. Group-A, 32 females were given oral metformin 500 mg TDS while Group-B, 39 females were given insulin 0.8-0.9 mg/kg/dayin two divided doses subcutaneously. Patients were followed till term. Feto-maternal outcomes were evaluated in 25 patients in each group who completed the study. Results: When groups were compared, newborns in Group-B were significantly more in weight (p=0.01). Significant numbers of babies were delivered after 38 weeks of pregnancy in Group-B (P=0.021). There were two intrauterine deaths and significantly higher HbA(1)C at term in Group-B. (P=0.03). FBS at term was nonsignificant (p=0.079) and there was more number of cesarean sections due to feto-maternal disproportion in Group-B (28% vs. 2%). Results analyzed for glycemic control before and after the treatment revealed that FBS was statistically less in Group- A (p=0.00) whereas for Group-B the value of FBS and HbA(1)C was statistically high. (p=0.002 & 0.04 respectively). Conclusion: Metformin has produced better effects on feto-maternal outcomes and glycemic control in comparison to Insulin in GDM.