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
Meta-Analysis
. 2017 Jun 24;7(6):e015557.
doi: 10.1136/bmjopen-2016-015557.

Treatments for gestational diabetes: a systematic review and meta-analysis

Diane Farrar  1 , Mark Simmonds  2 , Maria Bryant  3 , Trevor A Sheldon  4 , Derek Tuffnell  5 , Su Golder  6 , Debbie A Lawlor  7
Affiliations
Meta-Analysis

Treatments for gestational diabetes: a systematic review and meta-analysis

Diane Farrar et al. BMJ Open. .

Abstract

Objective: To investigate the effectiveness of different treatments for gestational diabetes mellitus (GDM).

Design: Systematic review, meta-analysis and network meta-analysis.

Methods: Data sources were searched up to July 2016 and included MEDLINE and Embase. Randomised trials comparing treatments for GDM (packages of care (dietary and lifestyle interventions with pharmacological treatments as required), insulin, metformin, glibenclamide (glyburide)) were selected by two authors and double checked for accuracy. Outcomes included large for gestational age, shoulder dystocia, neonatal hypoglycaemia, caesarean section and pre-eclampsia. We pooled data using random-effects meta-analyses and used Bayesian network meta-analysis to compare pharmacological treatments (ie, including treatments not directly compared within a trial).

Results: Forty-two trials were included, the reporting of which was generally poor with unclear or high risk of bias. Packages of care varied in their composition and reduced the risk of most adverse perinatal outcomes compared with routine care (eg, large for gestational age: relative risk0.58 (95% CI 0.49 to 0.68; I2=0%; trials 8; participants 3462). Network meta-analyses suggest that metformin had the highest probability of being the most effective treatment in reducing the risk of most outcomes compared with insulin or glibenclamide.

Conclusions: Evidence shows that packages of care are effective in reducing the risk of most adverse perinatal outcomes. However, trials often include few women, are poorly reported with unclear or high risk of bias and report few outcomes. The contribution of each treatment within the packages of care remains unclear. Large well-designed and well-conducted trials are urgently needed.

Trial registration number: PROSPERO CRD42013004608.

Keywords: gestational diabetes; glibenclamide (glyburide); insulin; meta-analysis; metformin; network analysis; packages of care; systematic review; treatments.

PubMed Disclaimer

Conflict of interest statement

Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1
Search process.
Figure 2
Figure 2
Forest plots for treatment comparisons and perinatal outcomes. (A) Packages of care (starting with dietary modification) versus routine care: dichotomous outcomes. (B) Packages of care (starting with dietary modification) versus routine care: continuous outcomes. (C) Metformin versus insulin: dichotomous outcomes. (D) Metformin versus insulin: continuous outcomes. (E) Glibenclamide versus insulin: dichotomous outcomes. (F) Glibenclamide versus insulin: continuous outcomes. (G) Glibenclamide versus metformin: dichotomous outcomes. (H) Glibenclamide versus metformin: continuous outcomes.
Figure 3
Figure 3
Network meta-analysis, relationship of treatment comparisons.
Figure 4
Figure 4
Network meta-analysis comparing metformin, glibenclamide and insulin. First better, treatment listed first in the outcome column is superior; second better, treatment listed second in the outcome column is superior. C-section, caesarean section; LGA, large for gestational age; NICU, neonatal intensive care unit.
See this image and copyright information in PMC

References

    1. Alwan N, Tuffnell D, West J, et al. Treatments for gestational diabetes. Cochrane Database of Syst Rev 2009;3:CD003395. - PMC - PubMed
    1. Gui J, Liu Q, Feng L. Metformin vs insulin in the management of gestational diabetes: a meta-analysis. PLoS One 2013;8:e64585 10.1371/journal.pone.0064585 - DOI - PMC - PubMed
    1. Hartling L, Dryden DM, Guthrie A, et al. Benefits and harms of treating gestational diabetes mellitus: a systematic review and meta-analysis for the U.S. Preventive Services Task Force and the National Institutes of Health Office of Medical Applications of Research. Ann Intern Med 2013;159:123–9. 10.7326/0003-4819-159-2-201307160-00661 - DOI - PubMed
    1. Falavigna M, Prestes I, Schmidt MI, et al. Impact of gestational diabetes mellitus screening strategies on perinatal outcomes: a simulation study. Diabetes Res Clin Pract 2013;99:358–65. 10.1016/j.diabres.2012.12.009 - DOI - PubMed
    1. Horvath K, Koch K, Jeitler K, et al. Effects of treatment in women with gestational diabetes mellitus: systematic review and meta-analysis. BMJ 2010;340:c1395–413. 10.1136/bmj.c1395 - DOI - PMC - PubMed