Metformin vs insulin in the management of gestational diabetes: a meta-analysis.
Metformin vs insulin in the management of gestational diabetes: a meta-analysis.
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DOI：
10.1371/journal.pone.0064585
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发表时间：
2013
期刊：
影响因子：
3.7
通讯作者：
Feng L
中科院分区：
文献类型：
--
作者：
Gui J;Liu Q;Feng L
如今，越来越多的研究将二甲双胍与胰岛素进行比较。但孕妇使用二甲双胍仍存在争议，因此，我们旨在通过随机对照试验（RCT）的荟萃分析来比较二甲双胍与胰岛素对妊娠糖尿病（GDM）血糖控制、孕产妇和新生儿结局的影响，以检验二甲双胍的有效性和安全性。我们将关键词“妊娠糖尿病”与“二甲双胍”结合使用，并检索了包括 Pubmed、Cochrane 图书馆、Web of Knowledge 和临床试验注册数据库在内的数据库。使用随机效应模型来计算汇总风险估计。对涉及 1270 名参与者的 5 项随机对照试验的荟萃分析发现，二甲双胍组入组后的平均体重增加要低得多（n = 1006，P = 0.003，SMD = −0.47，95%CI [−0.77 至 -0.16]）；二甲双胍组的平均分娩胎龄显着较低（n = 1270，P = 0.02，SMD = −0.14，95%CI [−0.25 至 -0.03]）；二甲双胍组的早产发生率明显更高（n = 1110，P = 0.01，OR = 1.74，95%CI [1.13, 2.68]）；二甲双胍组妊娠高血压的发生率显着降低（n = 1110，P = 0.02，OR = 0.52，95%CI [0.30, 0.90]）。仅二甲双胍组的 OGTT 空腹血糖水平显着低于补充胰岛素组（n = 478，P = 0.0006，SMD = −0.83，95%CI [−1.31 至 -0.36]）。二甲双胍在血糖控制和新生儿结局方面与胰岛素相当。它可能更适合患有轻度 GDM 的女性。该荟萃分析还提供了在 GDM 中使用二甲双胍的一些显着益处和风险，并有助于为管理指南的进一步制定提供信息。
Nowadays, there have been increasing studies comparing metformin with insulin. But the use of metformin in pregnant women is still controversial, therefore, we aim to examine the efficiency and safety of metformin by conducting a meta-analysis of randomized controlled trials (RCTs) comparing the effects of metformin with insulin on glycemic control, maternal and neonatal outcomes in gestational diabetes mellitus (GDM). We used the key words “gestational diabetes” in combination with “metformin” and searched the databases including Pubmed, the Cochrane Library, Web of knowledge, and Clinical Trial Registries. A random-effects model was used to compute the summary risk estimates. Meta-analysis of 5 RCTs involving 1270 participants detected that average weight gains after enrollment were much lower in the metformin group (n = 1006, P = 0.003, SMD = −0.47, 95%CI [−0.77 to −0.16]); average gestational ages at delivery were significantly lower in the metformin group (n = 1270, P = 0.02, SMD = −0.14, 95%CI [−0.25 to −0.03]); incidence of preterm birth was significantly more in metformin group (n = 1110, P = 0.01, OR = 1.74, 95%CI [1.13 to 2.68]); the incidence of pregnancy induced hypertension was significantly less in the metformin group (n = 1110, P = 0.02, OR = 0.52, 95%CI [0.30 to 0.90]). The fasting blood sugar levels of OGTT were significantly lower in the metformin only group than in the supplemental insulin group (n = 478, P = 0.0006, SMD = −0.83, 95%CI [−1.31 to −0.36]). Metformin is comparable with insulin in glycemic control and neonatal outcomes. It might be more suitable for women with mild GDM. This meta-analysis also provides some significant benefits and risks of the use of metformin in GDM and help to inform further development of management guidelines.
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