Gestational diabetes: treatment with metformin compared to insulin

当女性在怀孕期间检测到血糖水平升高时，就会诊断为妊娠期糖尿病(GDM)。治疗的目的是保持母亲的血糖正常，并防止额外的糖转移到婴儿身上，因为这可能会导致婴儿胰岛素水平升高，以及随后的并发症。最初的治疗是通过饮食，但超过30%的女性需要进一步注射胰岛素。二甲双胍可以作为片剂服用，是胰岛素的替代品，广泛用于糖尿病患者的孕外治疗。有很好的数据支持二甲双胍在怀孕期间的安全性。我们计划测试二甲双胍不仅安全，而且是妊娠期糖尿病女性胰岛素的有效替代品。二甲双胍通过减少胰岛素抵抗发挥作用，胰岛素抵抗是妊娠期糖尿病发展和高血压并发症的关键因素。我们希望通过二甲双胍治疗来减少这些并发症。与胰岛素相比，二甲双胍与体重增加相关较少，我们希望证明服用二甲双胍治疗的妊娠期糖尿病妇女妊娠后糖尿病风险的相关降低。二甲双胍可能会穿过胎盘，如果是这样的话，它可能会降低婴儿体内升高的胰岛素水平。这项研究将测量脐带血中的胰岛素水平，希望证明更多的婴儿在接受二甲双胍治疗的怀孕期间胰岛素水平正常。

Gestational diabetes (GDM) is diagnosed when women have elevated blood sugar levels detected in pregnancy. Treatment aims to keep the mother's blood sugar normal and to prevent extra sugar transferring to the baby, as this can lead to elevated insulin levels, and subsequent complications, in the baby. Initial treatment is by diet, but more than 30% of women need further treatment with insulin injections. Metformin, which can be taken by as a tablet, is an alternative to insulin that is used widely outside pregnancy for people with diabetes. There are good data to support the safety of metformin in pregnancy. We plan to test that metformin is not only safe but also an effective alternative to insulin for women with GDM. Metformin works by reducing resistance to insulin, which is a key factor for the development of GDM and also for high blood pressure complications. We hope to demonstrate a reduction in these complications with metformin treatment. Metformin is associated with less weight gain than insulin and we hope to demonstrate an associated reduction in the risk of diabetes following pregnancy in women with GDM treated with metformin. It is likely that metformin crosses the placenta, and if so, it may reduce elevated insulin levels in the baby. The study will measure insulin levels in the cord blood, hoping to demonstrate that more babies have normal insulin levels in pregnancies treated with metformin.