Patterns of glucose‐lowering therapies and neonatal outcomes in the treatment of gestational diabetes in Canada, 2009–2014. Issue 9 (13th July 2017)

• Record Type: Journal Article
• Authors: Bowker, S. L.; Savu, A; Yeung, R. O.; Johnson, J. A.; Ryan, E. A.; Kaul, P.
• Is Part Of: Diabetic medicine. Volume 34:Issue 9(2017)
• Page Start: 1296
• Page End: 1302
• Publication Date: 2017-07-13
• Subjects: Diabetes -- Periodicals; 616.462
• DOI: 10.1111/dme.13394
• Languages: English
• ISSNs: 0742-3071

Abstract

Abstract: Aim: To examine patterns of use of different glycaemic control agents for treating gestational diabetes mellitus. Methods: This was a large, retrospective, population‐based cohort study of pregnant women with gestational diabetes from Alberta, Canada. We linked data from the Alberta Vital Statistics – Birth database with administrative claims data. Alberta Vital Statistics – Birth data were used to identify births that occurred between 1 January 2009 and 31 December 2014. We used International Classification of Diseases version 9/10 codes to identify women with gestational diabetes, and we excluded women with pre‐existing diabetes. Results: Our cohort consisted of 16 857 women with gestational diabetes, with a total of 18 761 birth events between 2009 and 2014. Over the study period, the proportion of women with gestational diabetes who were treated with glycaemic control therapies increased from 25.0% to 31.4% ( P <0.0001). The number of pregnancies treated with insulin only increased (from 23.6% to 28.3%; P <0.0001), as did the number treated with metformin, +/– insulin (from 1.4% to 3.2%; P <0.0001). Rates of large‐for‐gestational‐age infants were significantly higher among pregnancies treated with insulin only (17%) or metformin (16.5%) than among pregnancies that did not receive any pharmacological treatment (12.8%). Conclusions: Our findings show increasing use of insulin and metformin in women with gestational diabetes. Rates of large‐for‐gestational‐age infants were similar among pregnant women receiving either pharmacological treatment, and higher than among pregnant women who did not receive any pharmacological treatment. Future research should explore the long‐term outcomes and safety of metformin as an alternative for treating gestational diabetes. What's new?: There are currently limited population‐level data on the use of various glucose‐lowering agents in treating gestational diabetes mellitus (GDM). We examined the changing pattern of use of insulin and/or metformin during pregnancy over a 6‐year period, from 2009 to 2014, among 16 857 women with GDM. We compared birth weight, and large for gestational age (LGA) infant rates among women who received insulin, metformin (+/– insulin), and no pharmacological treatment for GDM. Rates of pharmacological treatment of GDM increased over time. Rates of LGA infants were similar among pregnancies receiving either insulin or metformin +/– insulin, and higher than among those with no pharmacological treatment.