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. 2022 Dec 2:10:980578.
doi: 10.3389/fpubh.2022.980578. eCollection 2022.

Efficacy and safety of hypoglycemic agents on gestational diabetes mellitus in women: A Bayesian network analysis of randomized controlled trials

Ting Wang  1   2 , Yingyu Jing  3 , Haonan Guo  3 , Jing Xu  1 , Man Wang  4 , Lili Huang  5 , Huan Chen  3 , Wei Cui  3 , Lin Song  6 , Xiang Liu  7 , Bo Sun  6 , Ning Wang  1   8
Affiliations

Efficacy and safety of hypoglycemic agents on gestational diabetes mellitus in women: A Bayesian network analysis of randomized controlled trials

Ting Wang et al. Front Public Health. .

Abstract

Objective: To compare the efficacy and safety of metformin, glyburide, and insulin for GDM, we conducted a subgroup analysis of outcomes for women with GDM according to the International Association of Diabetes and Pregnancy Study Groups (IADPSG) diagnostic criteria.

Methods: We searched the NCBI, Embase, and Web of Science databases from inception to March 2022. Randomized controlled trials (RCTs) that compared the outcomes of hypoglycemic agents in women with GDM were included. Bayesian network analysis was employed.

Results: A total of 29 RCTs were included. Metformin was estimated to lead to a slight improvement in total gestational weight gain (WMD - 1.24 kg, 95% CI -2.38, -0.09), a risk of unmet treatment target in the sensitivity analysis (OR 34.50, 95% CI 1.18-791.37) than insulin. The estimated effect of metformin showed improvements in birth weight than insulin (WMD - 102.58 g, 95% CI -180.45 to -25.49) and glyburide (WMD - 137.84 g, 95% CI -255.31 to -25.45), for hypoglycemia within 1 h of birth than insulin (OR 0.65, 95% CI 0.47 to 0.84). The improvement in the estimated effect of metformin for hypoglycemia within 1 h of birth still existed when compared with glyburide (OR 0.41, 95% CI 0.26 to 0.66), whether in the IADPSG group (OR 0.33, 95% CI 0.12 to 0.92) or not (OR 0.43, 95% CI 0.20 to 0.98).

Conclusion: Metformin is beneficial for GDM women to control total GWG compared with insulin, regulate fetal birth weight more than insulin and glyburide, and increase the risk of unmet treatment targets compared with insulin. Compared to metformin, glyburide is associated with neonatal hypoglycemia.

Keywords: Bayesian network analysis; gestational diabetes mellitus; glyburide; insulin; metformin; randomized controlled trials.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
PRISMA flowchart for the selection of studies. Figure manifested the process of retrieving, evaluating, selecting, or excluding relevant studies from the database. We employed the preferred reporting items for systematic reviews and meta-analyses (PRISMA) diagram for the search.
See this image and copyright information in PMC

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