Does Metformin vs Insulin Modify Later-Life Risk for Diabetes Among Women with Previous GDM?
BACKGROUND AND PURPOSE:
Gestational diabetes mellitus (GDM) treatment may modify the long-term risk of type 2 diabetes (T2D) and metabolic syndrome (MetS)
Hutala et al. (Acta Obstetricia et Gynecologica Scandinavica, 2022) determined whether the long-term incidences of T2D, pre-diabetes and MetS differed between women who were treated with metformin or insulin for GDM
9-year follow-up study of two open-label randomized trials
Women with GDM
Previous GDM treatment with metformin
Previous GDM treatment with insulin
Oral glucose tolerance tests were performed
Anthropometry, glucose metabolism, serum lipids and inflammatory markers between exposure groups were assessed
Pre-diabetes and T2D at 9-year follow-up
Previous treatment with metformin: 77 | Insulin: 88
Between the metformin treated and insulin treated groups, there was no difference in the incidence of
Pre-diabetes and T2D
Odds ratio (OR) 0.77 (95% CI, 0.40 to 1.50); P=0.51
OR 0.88 (95% CI, 0.34 to 2.26); P=0.94
OR 0.79 (95% CI, 0.38 to 1.65); P=0.62
OR 0.69 (95% CI, 0.35 to 1.35); P=0.31
There was also no difference in the individual measures of any of the following
Glucose metabolism including HOMA-insulin resistance
There does not appear to be a difference in the incidence of later-life T2D, pre-diabetes, or MetS when women with GDM were treated with metformin vs insulin
The authors state
The available data regarding long-term metabolic effects of the main pharmacological treatment options for GDM have been scarce
Based on our study, neither metformin nor insulin seems to be superior to the other regarding the long-term effects on maternal health
From this perspective, both treatments may be considered in GDM
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