妊娠糖尿病の治療法の比較

タイトル: Efficacy of Different Treatment Approaches (Insulin and Metformin) in Women with Gestational Diabetes Mellitus (GDM).

概要: Background and PurposeThe pharmacotherapy options in patients with GDM, are insulin or oral antihyperglycemic agents. Insulin is the preferred medication for treating hyperglycemia, but in recent years, metformin has been increasingly used in the treatment of GDM. The aimto assess the efficacy of different treatment (insulin and metformin) in women with GDM. MethodsScreening for GDM was performed in 2422 pregnant women and reveal GDM in 119 women (75-g OGTT was performed at 24-28 weeks of gestation). All patients started treated at 24 -29 weeks of gestations. The patients were divided into 2 groups (Gr.): Gr.1 - 68 patients, who treated with diet + insulin therapy Gr.2 - 51patients, who treated with diet + metformin. ResultsAt the 2nd trimester HbA1c (%) levels vas for Gr.1 and 2: 6.7 (0.05), 6.4 (0.6) respectively; By term HbA1c levels statistically decreased in both groups, but we did not found statistical difference between groups. Women from Gr.2 gained less weight compared to women from Gr.1 (1.89{+/-}3.88 vs 4.53{+/-}3.67 kg; P=0.003). In Gr.1 percent of pre-eclampsia was (2,9%) and in Gr.2(3,9%) (P= 0,7773, OR - 1,33), we did not find statistical difference between groups. The incidence of preterm delivery before 37 weeks of gestation in Gr1 was lower, than in Gr.2 (P=0.7311, OR -1,33) and we also did not find a statistical difference between groups. Perinatal mortality was observed in Gr.1 - 1.4% and in Gr.2 - 1,9% (P =0.8402, OR -1,33). In both groups we observed high percent Cesarean section (Gr.1 - 32.3% and Gr.2 - 29.4% (P=0.7651, OR -1,0909), but we did not find a statistical difference between the groups. In both groups, percent of macrosomia was high, despite good glycemic control maintained through pregnancies: 20.0% and 23.0%, for Gr.1 and Gr.2, respectively (P =0.9236, OR -1,0256), and again no statistical difference was found between the groups. Percent of neonatal hypoglycemia was lower in Gr.2 (1.9%), than in Gr.1 (4.41%) (P=0.9236, OR -1,0256).. Percent of respiratory distress syndrome was 2.94% and in 3.92% for Gr.1 and Gr.2, respectively (P= 0.9694, OR - 0.9893), with no statistical difference between the groups. ConclusionsWe did not find differences between patients who treated with diet + insulin therapy and with diet + metformin. Percent of preeclampsia, preterm delivery, macrosomia and perinatal death was similar in both groups, only maternal weight gain was lower in the metformin group.