PDF herunterladen
CC BY 4.0 · Rev Bras Ginecol Obstet 2019; 41(12): 697-702
DOI: 10.1055/s-0039-1700796
Original Article
Thieme Revinter Publicações Ltda Rio de Janeiro, Brazil

Factors Associated with the Need for Insulin as a Complementary Treatment to Metformin in Gestational Diabetes Mellitus

Fatores associados à necessidade de insulina como tratamento complementar à metformina na diabetes mellitus gestacional
Matheus Leite Ramos de Souza 
1   Department of Medicine, Universidade da Região de Joinville, Joinville, SC, Brazil
,
Rodrigo Ribeiro e Silva
1   Department of Medicine, Universidade da Região de Joinville, Joinville, SC, Brazil
,
Thiago Ribeiro e Silva
2   Department of Medicine, Universidade Positivo, Curitiba, PR, Brazil
,
Larissa Cano de Oliveira
1   Department of Medicine, Universidade da Região de Joinville, Joinville, SC, Brazil
,
Guilherme Dienstmann
1   Department of Medicine, Universidade da Região de Joinville, Joinville, SC, Brazil
,
Iramar Baptistella do Nascimento
1   Department of Medicine, Universidade da Região de Joinville, Joinville, SC, Brazil
,
Jean Carl Silva
1   Department of Medicine, Universidade da Região de Joinville, Joinville, SC, Brazil
› Institutsangaben Funding The present research did not receive any specific grant or funding from agencies in the public, private, or not-for-profit sectors.
Weitere Informationen

Publikationsverlauf

07. Juni 2019

09. September 2019

Publikationsdatum:
19. Dezember 2019 (online)

   Lizenzen und Reprints

Abstract

Objective To evaluate the factors associated with the need for insulin as a complementary treatment to metformin in pregnant women with gestational diabetes mellitus (GDM).

Methods A case-control study was performed from April 2011 to February 2016 with pregnant women with GDM who needed complementary treatments besides diet and physical exercise. Those treated with metformin were compared with those who, in addition to metformin, also needed the combination with insulin. Maternal characteristics and glycemic control were evaluated. Multinomial logistic regression models were developed to evaluate the influence of different therapies on neonatal outcomes.

Results A total of 475 pregnant women who needed pharmacological therapy were evaluated. Of these, 366 (77.05%) were submitted to single therapy with metformin, and 109 (22.94%) needed insulin as a complementary treatment. In the analysis of the odds ratio (OR), fasting glucose (FG) < 90 mg/dL reduced the odds of needing the combination (OR: 0.438 [0.235–0.815]; p = 0.009], as well as primiparity (OR: 0.280 [0.111–0.704]; p = 0.007]. In obese pregnant women, an increased chance of needing the combination was observed (OR: 2,072 [1,063–4,039]; p = 0,032).

Conclusion Obesity resulted in an increased chance of the mother needing insulin as a complementary treatment to metformin, while FG < 90 mg/dL and primiparity were protective factors.

Resumo

Objetivo Avaliar os fatores associados à necessidade de insulina como tratamento complementar à metformina em gestantes com diabetes mellitus gestacional (DMG).

Métodos Um estudo caso-controle foi realizado de abril de 2011 a fevereiro de 2016 com gestantes portadoras de DMG que necessitaram de tratamentos complementares além de dieta e exercícios físicos. Aquelas tratadas com metformina foram comparadas com aquelas que, além da metformina, também precisaram de combinação com insulina. Foram avaliadas as características maternas e de controle glicêmico. Modelos de regressão logística multinomial foram construídos para avaliar a influência das diferentes terapias nos desfechos neonatais.

Resultados Foram avaliadas 475 gestantes que necessitaram de terapia farmacológica. Destas, 366 (77,05%) utilizaram terapia única com metformina, e 109 (22,95%) necessitaram de insulina como tratamento complementar. Na análise da razão de possibilidades (RP), a glicemia de jejum (GJ) < 90 mg/dL reduziu as chances de necessidade da combinação (RP: 0,438 [0,235–0,815]; p = 0,009), bem como a primiparidade (RP: 0,280 [0,111–0,704]; p = 0,007). Em gestantes obesas, foi observada uma chance maior de necessidade da combinação (RP: 2.072 [1.063–4.039]; p = 0,032).

Conclusão A obesidade resultou em um aumento na chance de a mãe precisar de insulina como tratamento complementar à metformina, enquanto a GJ < 90 mg/dL e a primiparidade foram fatores de proteção.

Keywords

gestational diabetes - metformin - insulin - combined treatment

Palavras-chave

diabetes gestacional - metformina - insulina - tratamento combinado
 

  • References

  • 1 Oliveira JEP, Montenegro Junior RM, Vencio S. . orgs. Diretrizes da Sociedade Brasileira de Diabetes 2017–2018. São Paulo, SP: Clannad; 2017
    Suche in Google Scholar
  • 2 National Collaborating Centre for Women's and Children's Health. Diabetes in Pregnancy: Management of Diabetes and its Complications from Preconception to the Postnatal Period. London: National Institute for Health and Care Excellence; 2015
    Suche in Google Scholar
  • 3 Organização Pan-Americana da Saúde, Ministério da Saúde, Federação Brasileira das Associações de Ginecologia e Obstetrícia, Sociedade Brasileira de Diabetes. Rastreamento e Diagnóstico de Diabetes Mellitus Gestacional no Brasil. Brasília, DF: OPAS; 2017
    Suche in Google Scholar
  • 4 Gray SG, McGuire TM, Cohen N, Little PJ. The emerging role of metformin in gestational diabetes mellitus. Diabetes Obes Metab 2017; 19 (06) 765-772 . Doi: 10.1111/dom.12893
    CrossrefPubMedSuche in Google Scholar
  • 5 Singh A, Dwivedi S. Study of adverse drug reactions in patients with diabetes attending a tertiary care hospital in New Delhi, India. Indian J Med Res 2017; 145 (02) 247-249 . Doi: 10.4103/ijmr.IJMR_109_16
    PubMedSuche in Google Scholar
  • 6 Ma RCW, Tutino GE, Lillycrop KA, Hanson MA, Tam WH. Maternal diabetes, gestational diabetes and the role of epigenetics in their long term effects on offspring. Prog Biophys Mol Biol 2015; 118 (1-2): 55-68 . Doi: 10.1016/j.pbiomolbio.2015.02.010
    CrossrefPubMedSuche in Google Scholar
  • 7 Teh WT, Teede HJ, Paul E, Harrison CL, Wallace EM, Allan C. Risk factors for gestational diabetes mellitus: implications for the application of screening guidelines. Aust N Z J Obstet Gynaecol 2011; 51 (01) 26-30 . Doi: 10.1111/j.1479-828X.2011.01292.x
    CrossrefPubMedSuche in Google Scholar
  • 8 Brown J, Alwan NA, West J. , et al. Lifestyle interventions for the treatment of women with gestational diabetes. Cochrane Database Syst Rev 2017; 5: CD011970 . Doi: 10.1002/14651858.CD011970.pub2
    PubMedSuche in Google Scholar
  • 9 American Diabetes Association. Lifestyle management: standards of medical care in diabetes-2018. Diabetes Care 2018; 41 (Suppl. 01) S38-S50 . Doi: 10.2337/dc18-S004
    CrossrefPubMedSuche in Google Scholar
  • 10 Kalra B, Gupta Y, Singla R, Kalra S. Use of oral anti-diabetic agents in pregnancy: a pragmatic approach. N Am J Med Sci 2015; 7 (01) 6-12 . Doi: 10.4103/1947-2714.150081
    CrossrefPubMedSuche in Google Scholar
  • 11 Silva JC, Fachin DRRN, Coral ML, Bertini AM. Perinatal impact of the use of metformin and glyburide for the treatment of gestational diabetes mellitus. J Perinat Med 2012; 40 (03) 225-228 . Doi: 10.1515/jpm-2011-0175
    CrossrefPubMedSuche in Google Scholar
  • 12 Sinai Talaulikar V, Tang T, Yasmin E. Role of metformin in women's health: review of its current place in clinical practice and emerging indications for future. Obstet Gynecol Surv 2016; 71 (05) 307-317 . Doi: 10.1097/OGX.0000000000000312
    CrossrefPubMedSuche in Google Scholar
  • 13 Haas J, Bentov Y. Should metformin be included in fertility treatment of PCOS patients?. Med Hypotheses 2017; 100: 54-58 . Doi: 10.1016/j.mehy.2017.01.012
    CrossrefPubMedSuche in Google Scholar
  • 14 Tan X, Li S, Chang Y. , et al. Effect of metformin treatment during pregnancy on women with PCOS: a systematic review and meta-analysis. Clin Invest Med 2016; 39 (04) E120-E131
    CrossrefPubMedSuche in Google Scholar
  • 15 Silva JC, Souza BV, Silva MR. Preditores de sucesso da metformina no tratamento do diabetes mellitus gestacional. Rev Bras Saúde Mater Infant 2013; 13: 129-135 . Doi: 10.1590/S1519-38292013000200006
    CrossrefPubMedSuche in Google Scholar
  • 16 Ashoush S, El-Said M, Fathi H, Abdelnaby M. Identification of metformin poor responders, requiring supplemental insulin, during randomization of metformin versus insulin for the control of gestational diabetes mellitus. J Obstet Gynaecol Res 2016; 42 (06) 640-647 . Doi: 10.1111/jog.12950
    CrossrefPubMedSuche in Google Scholar
  • 17 Padayachee C, Coombes JS. Exercise guidelines for gestational diabetes mellitus. World J Diabetes 2015; 6 (08) 1033-1044 . Doi: 10.4239/wjd.v6.i8.1033
    CrossrefPubMedSuche in Google Scholar
  • 18 do Valle JB, Silva JC, Oliveira DS, Martins L, Lewandowski A, Horst W. Use of a clinical-laboratory score to guide treatment of gestational diabetes. Int J Gynaecol Obstet 2018; 140 (01) 47-52 . Doi: 10.1002/ijgo.12326
    CrossrefPubMedSuche in Google Scholar
  • 19 McGrath RT, Glastras SJ, Hocking S, Fulcher GR. Use of metformin earlier in pregnancy predicts supplemental insulin therapy in women with gestational diabetes. Diabetes Res Clin Pract 2016; 116: 96-99 . Doi: 10.1016/j.diabres.2016.04.051
    CrossrefPubMedSuche in Google Scholar
  • 20 Pellonperä O, Rönnemaa T, Ekblad U, Vahlberg T, Tertti K. The effects of metformin treatment of gestational diabetes on maternal weight and glucose tolerance postpartum--a prospective follow-up study. Acta Obstet Gynecol Scand 2016; 95 (01) 79-87 . Doi: 10.1111/aogs.12788
    CrossrefPubMedSuche in Google Scholar
  • 21 Tertti K, Ekblad U, Vahlberg T, Rönnemaa T. Comparison of metformin and insulin in the treatment of gestational diabetes: a retrospective, case-control study. Rev Diabet Stud 2008; 5 (02) 95-101 . Doi: 10.1900/RDS.2008.5.95
    CrossrefPubMedSuche in Google Scholar
  • 22 Gante I, Melo L, Dores J, Ruas L, Almeida MDC. Metformin in gestational diabetes mellitus: predictors of poor response. Eur J Endocrinol 2018; 178 (01) 129-135 . Doi: 10.1530/EJE-17-0486
    CrossrefPubMedSuche in Google Scholar
  • 23 Khin MO, Gates S, Saravanan P. Predictors of metformin failure in gestational diabetes mellitus (GDM). Diabetes Metab Syndr 2018; 12 (03) 405-410 . Doi: 10.1016/j.dsx.2018.01.003
    CrossrefPubMedSuche in Google Scholar
  • 24 Ali A, Shastry S, Nithiyananthan R, Ali A, Ganapathy R. Gestational diabetes-Predictors of response to treatment and obstetric outcome. Eur J Obstet Gynecol Reprod Biol 2018; 220: 57-60 . Doi: 10.1016/j.ejogrb.2017.11.014
    CrossrefPubMedSuche in Google Scholar
  • 25 Sales WB, Nascimento IBD, Dienstmann G, Souza MLR, Silva GDD, Silva JC. Effectiveness of metformin in the prevention of gestational diabetes mellitus in obese pregnant women. Rev Bras Ginecol Obstet 2018; 40 (04) 180-187 . Doi: 10.1055/s-0038-1642632
    Thieme ConnectPubMedSuche in Google Scholar