Predictors found for poor metformin response in gestational diabetes
Age, higher pre-pregnancy body mass index (BMI) and earlier introduction of metformin could be used as predictors of poor response to the drug in gestational diabetes.
Metformin is often regarded as a first-line treatment in gestational diabetes mellitus (GDM) because of its safety and effectiveness.
However, a proportion of women do not achieve adequate glycemic control with the drug alone, so researchers wanted to identify predictors of what could indicate the poor response.
In a retrospective multicentre cohort study of women with GDM who started metformin as first-line treatment, the assessed cohort was divided into a metformin group and metformin plus insulin group.
Biometric and demographic characteristics, glycemic control data, obstetric, neonatal and postpartum outcomes were compared between groups and analysed in order to identify predictors of poor response to metformin.
Of the 388 women enrolled in the study, 135 (34.8 per cent) required additional insulin therapy to achieve the glycemic targets. Higher age, higher pre-pregnancy BMI and earlier introduction of metformin were found to be independent predictors for insulin supplementation.
Regarding all the analysed outcomes, only cesarean delivery rates and postpartum glucose levels were higher in women requiring insulin supplementation.
The team concluded that although almost 35 per cent of women did not achieve adequate glycemic control with metformin, insulin supplementation was not associated with poor neonatal outcomes.