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Fasting blood glucose predicts response to extended-release metformin in gestational diabetes mellitus
Citation
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 Statement
Copyright 2012 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists
Abstract
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 Details
Item Type: | Refereed Article |
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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 Division: | Health |
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) |
ID Code: | 91964 |
Year Published: | 2013 |
Web of Science® Times Cited: | 9 |
Deposited By: | Medicine |
Deposited On: | 2014-06-04 |
Last Modified: | 2014-08-05 |
Downloads: | 0 |
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