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Efficacy and Safety of Oral Antidiabetic Drugs in Comparison to Insulin in Treating Gestational Diabetes Mellitus: A Meta-Analysis

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  • Nalinee Poolsup
  • Naeti Suksomboon
  • Muhammad Amin

Abstract

Objective: To assess the efficacy and safety of oral antidiabetic drugs (OADs) in gestational diabetes mellitus (GDM) in comparison to insulin. Methods: A meta-analysis of randomized controlled trials was conducted. The efficacy and safety of OADs in comparison to insulin in GDM patients were explored. Studies were identified by conducting a literature search using the electronic databases of Medline, CENTRAL, CINAHL, LILACS, Scopus and Web of Science in addition to conducting hand search of relevant journals from inception until October 2013. Results: Thirteen studies involving 2,151 patients met the inclusion criteria. These studies were randomized controlled trials of metformin and glyburide in comparison to insulin therapy. Our results indicated a significant increase in the risk for preterm births (RR, 1.51; 95% CI, 1.04–2.19, p = 0.03) with metformin compared to insulin. However, a significant decrease in the risk for gestational hypertension (RR, 0.54; 95% CI, 0.31–0.91, p = 0.02) was found. Postprandial glucose levels also decreased significantly in patients receiving metformin (MD, −2.47 mg/dL; 95% CI, −4.00, −0.94, p = 0.002). There was no significant difference between the two groups for the remaining outcomes. There were significant increases in the risks of macrosomia (RR, 2.34; 95% CI, 1.18–4.63, p = 0.03) and neonatal hypoglycemia (RR, 2.06; 95% CI, 1.27–3.34, p = 0.005) in the glyburide group compared to insulin whereas results for the other analyzed outcomes remained non-significant. Conclusion: The available evidence suggests favorable effects of metformin in treating GDM patients. Metformin seems to be an efficacious alternative to insulin and a better choice than glyburide especially those with mild form of disease.

Suggested Citation

  • Nalinee Poolsup & Naeti Suksomboon & Muhammad Amin, 2014. "Efficacy and Safety of Oral Antidiabetic Drugs in Comparison to Insulin in Treating Gestational Diabetes Mellitus: A Meta-Analysis," PLOS ONE, Public Library of Science, vol. 9(10), pages 1-13, October.
    • Handle: RePEc:plo:pone00:0109985
    DOI: 10.1371/journal.pone.0109985
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    References listed on IDEAS

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    1. Juan Gui & Qing Liu & Ling Feng, 2013. "Metformin vs Insulin in the Management of Gestational Diabetes: A Meta-Analysis," PLOS ONE, Public Library of Science, vol. 8(5), pages 1-8, May.
    2. David Moher & Alessandro Liberati & Jennifer Tetzlaff & Douglas G Altman & The PRISMA Group, 2009. "Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement," PLOS Medicine, Public Library of Science, vol. 6(7), pages 1-6, July.
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    1. Rongjing Song & Ling Chen & Yue Chen & Xia Si & Yi Liu & Yue Liu & David M Irwin & Wanyu Feng, 2017. "Comparison of glyburide and insulin in the management of gestational diabetes: A meta-analysis," PLOS ONE, Public Library of Science, vol. 12(8), pages 1-18, August.

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