Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2015 Nov;80(5):1224-34.
doi: 10.1111/bcp.12672. Epub 2015 Jul 14.

Metformin versus insulin for gestational diabetes mellitus: a meta-analysis

Li-Ping Zhao  1   2 , Xiao-Yan Sheng  1 , Shuang Zhou  1   2 , Ting Yang  1 , Ling-Yue Ma  1 , Ying Zhou  1   2 , Yi-Min Cui  1   2
Affiliations
Review

Metformin versus insulin for gestational diabetes mellitus: a meta-analysis

Li-Ping Zhao et al. Br J Clin Pharmacol. 2015 Nov.

Abstract

The aim of the present meta-analysis was to determine the efficacy and safety of metformin for the treatment of women with gestational diabetes mellitus (GDM). We searched databases, including PubMed, Embase and the Cochrane Central Register of Controlled Trials, for randomized controlled trials (RCTs) comparing metformin and insulin treatments in women with GDM. We carried out statistical analyses using RevMan 2011 and used the Grading of Recommendations, Assessment, Development, and Evaluations profiler to rate the quality of evidence of the primary outcomes. We analysed eight studies involving 1592 subjects. Meta-analysis of the RCTs showed that metformin had statistically significant effects on pregnancy-induced hypertension [PIH; risk ratio (RR) 0.54; 95% confidence interval (CI) 0.31, 0.91]. However, its effects on neonatal hypoglycaemia (RR 0.80; 95% CI 0.62, 1.02), rate of large-for-gestational age infants (RR 0.77; 95% CI 0.55, 1.08), respiratory distress syndrome (RR 1.26; 95% CI 0.67, 2.37), phototherapy (RR 0.94; 95% CI 0.67, 1.31) and perinatal death (RR 1.01; 95% CI 0.11, 9.53) were not significant. Our analyses suggest that there is no clinically relevant difference in efficacy or safety between metformin and insulin; however, metformin may be a good choice for GDM because of the lower risk of PIH. The advantages of metformin in terms of glycaemic control, PIH incidence and gestational age at birth are unclear, and should be verified in further trials.

Keywords: gestational diabetes; insulin; metformin; randomized controlled trial.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Study flow diagram
Figure 2
Figure 2
Summary of risk of bias for each included study. +, low risk of bias; ?, unknown risk of bias.
Figure 3
Figure 3
Forest plots of primary outcomes of meta-analysis. (A) Neonatal hypoglycaemia; (B) Large for gestational age (LGA); (C) Respiratory distress syndrome (RDS); (D) Pregnancy-induced hypertension (PIH); (E) Perinatal death. CI, confidence interval; IV, intravenous.
See this image and copyright information in PMC

References

    1. American Diabetes Association. Gestational diabetes mellitus. Diabetes Care. 2003;26:S103–5. - PubMed
    1. Coustan DR, Lowe LP, Metzger BE, Dyer AR; International Association of Diabetes and Pregnancy Study Groups. Am J Obstet Gynecol. 2010;202:e1–6. . The Hyperglycemia and Adverse Pregnancy Outcome (HAPO) study: paving the way for new diagnostic criteria for gestational diabetes mellitus.: 654. - PMC - PubMed
    1. Korucuoglu U, Biri A, Turkyilmaz E, Doga Yildirim F, Ilhan M, Hirfanoglu IM, Atalay Y. Glycemic levels with glucose loading test during pregnancy and its association with maternal and perinatal outcomes. Diabetes Res Clin Pract. 2008;80:69–74. - PubMed
    1. HAPO Study Cooperative Research Group. Metzger BE, Lowe LP, Dyer AR, Trimble ER, Chaovarindr U, Coustan DR, Hadden DR, McCance DR, Hod M, McIntyre HD, Oats JJ, Persson B, Rogers MS, Sacks DA. Hyperglycemia and adverse pregnancy outcomes. N Engl J Med. 2008;358:1991–2002. - PubMed
    1. United Kingdom Prospective Diabetes Study (UKPDS) Relative efficacy of randomly allocated diet, sulphonylurea, insulin, or metformin in patients with newly diagnosed non-insulin dependent diabetes followed for three years. BMJ. 1995;310:83–8. - PMC - PubMed