The Pharmaceutical Journal
Vol 280 No 7501 p559
10 May 2008

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Metformin safe and effective to treat diabetes that develops in pregnancy, say researchers

Metformin is a safe and effective treatment for women with gestational diabetes mellitus, a study published this week in The New England Journal of Medicine confirms (2008;358:2003).

Researchers randomly assigned 751 women with gestational diabetes at 20 to 33 weeks of pregnancy to receive open treatment with metformin (with supplemental insulin if required) or insulin. They found that metformin, alone or in conjunction with supplemental insulin, was not associated with an increase in neonatal complications compared with insulin.

Rates of neonatal hypoglycaemia were similar in each group, but severe hypoglycaemia (<1.6mmol of glucose per litre) occurred significantly less in infants of women taking metformin.

However, the frequency of preterm birth was found to be higher in the metformin group. The difference could be due to chance or to an unrecognised effect of metformin on the labour process, the researchers suggest.

Overall, metformin was reported to be a more acceptable treatment than insulin but the researchers comment: “Clinicians may remain circumspect about using metformin until follow-up data for offspring are available.”

Recent guidance from the National Institute for Health and Clinical Excellence says that hypoglycaemic therapy for women with gestational diabetes — which may include regular insulin, rapid-acting insulin analogues (aspart and lispro) and/or the oral hypoglycaemic agents metformin and glibenclamide — should be tailored to the glycaemic profile of, and acceptability to, the individual woman.