Corbould, A and Swinton, F and Radford, A and Campbell, J and McBeath, S and Dennis, A, Fasting blood glucose predicts response to extended-release metformin in gestational diabetes mellitus, Australian and New Zealand Journal of Obstetrics and Gynaecology, 53, (2) pp. 125-129. ISSN 0004-8666 (2013) [Refereed Article]
Copyright 2012 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists
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.
|Item Type:||Refereed Article|
|Keywords:||body mass index, diabetes gestational, glucose tolerance test, insulin, metformin|
|Research Division:||Biomedical and Clinical Sciences|
|Research Group:||Medical biochemistry and metabolomics|
|Research Field:||Medical biochemistry - carbohydrates|
|Objective Group:||Clinical health|
|Objective Field:||Clinical health not elsewhere classified|
|UTAS Author:||Corbould, A (Dr Anne Corbould)|
|UTAS Author:||Dennis, A (Associate Professor Amanda Dennis)|
|Web of Science® Times Cited:||9|
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