This is the Medscape Medical Minute. I'm Dr George Lundberg.
In the absence of published randomized trials, what is the best way to manage gestational diabetes? Five investigators in Auckland, New Zealand report in The New England Journal of Medicine in 2008[1] on a randomized controlled open trial of 751 women with gestational diabetes at 20–33 weeks of gestation. One group was treated with insulin and the other with metformin and supplemental insulin if needed. Outcome measures included neonatal hypoglycemia, respiratory distress, need for photo therapy, birth trauma, Apgar score, prematurity, neonatal anthropomorphic measurements, maternal glycemic control and hypertensive complications, postpartum glucose tolerance, and acceptability of treatment. Results showed no significant differences in outcomes, although nearly half of the metformin group did receive supplemental insulin. There were no serious adverse effects from metformin and the women preferred it.
This article is selected from Medscape Best Evidence.[2] I'm Dr George Lundberg.
Footnotes
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References
- 1.Rowan JA, Hague WM, Gao W, Battin MR, Moore MP. Metformin versus insulin for the treatment of gestational diabetes. N Engl J Med. 2008;358:2003–2015. doi: 10.1056/NEJMoa0707193. [DOI] [PubMed] [Google Scholar]
- 2.Womens Health in Medscape Best Evidence, powered by McMaster Plus. Available at: http://www.medscape.com/pages/features/newsletters/bestevidence/womenshealth Accessed July 23, 2008.
