Metformin is comparable to insulin for pharmacotherapy in gestational diabetes mellitus: A network meta-analysis evaluating 6046 women. (May 2021)

• Record Type: Journal Article
• Authors: Musa, Omran A.H.; Syed, Asma; Mohamed, Aisha M.; Chivese, Tawanda; Clark, Justin; Furuya-Kanamori, Luis; Xu, Chang; Toft, Egon; Bashir, Mohammed; Abou-Samra, Abdul Badi; Thalib, Lukman; Doi, Suhail A.
• Is Part Of: Pharmacological research. Volume 167(2021)
• Publication Date: 2021-05
• Subjects: Gestational diabetes -- Pharmacotherapy -- Metformin -- Glibenclamide -- Insulin -- Core outcome set -- Network -- Meta-analysis; Pharmacology -- Periodicals; Pharmacology -- Periodicals; Research -- Periodicals; Médicaments -- Recherche -- Périodiques; Pharmacologie -- Périodiques; 615.105
• DOI: 10.1016/j.phrs.2021.105546
• Languages: English
• ISSNs: 1043-6618

Abstract

Abstract: Context: The comparative efficacy of gestational diabetes (GDM) treatments lack conclusive evidence for choice of first-line treatment. Objectives: The aim of this study was to compare the efficacy of metformin and glibenclamide to insulin using a core outcome set (COS) to unify outcomes across trials investigating the treatment of gestational diabetes mellitus. Study design: A network meta-analysis (NMA) was conducted. Data-source: PubMed, Embase, and Cochrane Controlled Register of Trials were searched from inception to January 2020. Study selection: RCTs that enrolled pregnant women who were diagnosed with GDM and that compared the efficacy of different pharmacological interventions for the treatment of GDM were included. Meta-analysis: A generalized pairwise modelling framework was employed. Results: A total of 38 RCTs with 6046 participants were included in the network meta-analysis. Compared to insulin, the estimated effect of metformin indicated improvements for weight gain (WMD −2·39 kg; 95% CI −3·31 to −1·46), maternal hypoglycemia (OR 0.34; 95% CI 0.12 to 0·97) and LGA (OR 0.61; 95% CI 0.38 to 0·98). There were also improvements in estimated effects for neonatal hypoglycemia (OR 0.48; 95% CI 0.19 to 1·25), pregnancy induced hypertension (OR 0.63; 95% CI 0.37 to 1·06), and preeclampsia (OR 0.74; 95% CI 0.538 to 1·04), though with limited evidence against our model hypothesis of equivalence with insulin for these outcomes. Conclusion: Metformin is, at least, comparable to insulin for the treatment of GDM. Glibenclamide appears less favorable, in comparison to insulin, than metformin. Graphical Abstract: ga1