Document Detail


Fasting blood glucose predicts response to extended-release metformin in gestational diabetes mellitus.
MedLine Citation:
PMID:  23205962     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Metformin is increasingly accepted as an alternative to insulin therapy in gestational diabetes mellitus (GDM). The Metformin in Gestational Diabetes (MiG) trial reported similar pregnancy outcomes for metformin versus insulin; however, supplemental insulin was required in 46% of women on metformin.
AIMS: We aimed to identify predictors of response to metformin monotherapy in women with GDM attending a general hospital antenatal clinic.
METHODS: We offered extended-release metformin to women diagnosed with GDM (ADIPS 1998 criteria) at ≥24 weeks of gestation. If glucose targets were not achieved (≤5.0 mmol/L fasting, ≤6.7 mmol/L two-h post-meal), women were changed to insulin. We carried out an audit to determine characteristics of metformin responders versus nonresponders.
RESULTS: Twenty-five women chose initial metformin therapy; 16 (64%) achieved satisfactory glycaemic control (responders). Nine women (36%) were changed to insulin: seven due to inadequate control (nonresponders) and two had metformin intolerance. Fasting glucose at oral glucose tolerance test (OGTT) was significantly lower in metformin responders versus nonresponders; two-h glucose and BMI did not differ. Ninety-three percent of women with fasting glucose ≤5.2 mmol/L responded to metformin: conversely, at fasting glucose >5.2 mmol/L, 33% responded (P = 0.005). Neonatal outcomes were similar in metformin responders and nonresponders, women who chose initial insulin therapy (n = 25), or were diet-controlled (n = 21).
CONCLUSIONS: In women with GDM, fasting glucose on OGTT predicted response to metformin: at fasting glucose ≤5.2 mmol/L, the probability of response was 93%. Antenatal clinics should determine locally relevant predictors of response to metformin in women with GDM.
Authors:
Anne Corbould; Fiona Swinton; Andrea Radford; Joanne Campbell; Sue McBeath; Amanda Dennis
Publication Detail:
Type:  Journal Article     Date:  2012-12-04
Journal Detail:
Title:  The Australian & New Zealand journal of obstetrics & gynaecology     Volume:  53     ISSN:  1479-828X     ISO Abbreviation:  Aust N Z J Obstet Gynaecol     Publication Date:  2013 Apr 
Date Detail:
Created Date:  2013-04-12     Completed Date:  2013-12-09     Revised Date:  2014-01-15    
Medline Journal Info:
Nlm Unique ID:  0001027     Medline TA:  Aust N Z J Obstet Gynaecol     Country:  Australia    
Other Details:
Languages:  eng     Pagination:  125-9     Citation Subset:  IM    
Copyright Information:
© 2012 The Authors ANZJOG © 2012 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.
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MeSH Terms
Descriptor/Qualifier:
Adult
Blood Glucose / analysis
Delayed-Action Preparations
Diabetes, Gestational / blood,  diet therapy,  drug therapy*
Female
Glucose Tolerance Test
Humans
Hypoglycemic Agents / adverse effects,  therapeutic use*
Insulin / therapeutic use
Metformin / adverse effects,  therapeutic use*
Predictive Value of Tests
Pregnancy
Premature Birth / etiology
Chemical
Reg. No./Substance:
0/Blood Glucose; 0/Delayed-Action Preparations; 0/Hypoglycemic Agents; 0/Insulin; 9100L32L2N/Metformin
Comments/Corrections
Comment In:
Aust N Z J Obstet Gynaecol. 2013 Dec;53(6):596-7   [PMID:  24289065 ]
Aust N Z J Obstet Gynaecol. 2013 Dec;53(6):597-8   [PMID:  24289066 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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