Brick by Brick: Metformin for Gestational Diabetes Mellitus?

Jean-Luc Ardilouze; Masoud Mahdavian; Jean-Patrice Baillargeon

Disclosures

Expert Rev Endocrinol Metab. 2010;5(3):353-357. 

In This Article

Five-year View

In 2004, only 4 years after Langer et al. published the results of their comparative study of glyburide and insulin,[12] it was shown that 18% of US obstetricians prescribed glyburide as first-line pharmacotherapy.[26] Next came the Rowan et al. paper (MiG trial), which was released in May 2008.[11] Thus, to our knowledge, no assessment of routine metformin prescription has yet been published.

One may speculate that for some practitioners, metformin use will probably regularly increase over the next 5 years, although caution would warrant waiting for the results of the long-term follow-up of offspring before using OHA. In the clinic, physicians will be pressured by women who dread to inject insulin, but also by a growing body of scientific evidence pointing to the use of OHA during pregnancy, as well as by professional recommendations for the use of OHA in particular cases.

Clinically speaking, GDM can be likened to Type 2 diabetes mellitus with a rapid 9-month evolution. From this standpoint, use of a combination of both metformin and glyburide seems advisable as their combined use should overcome the failure rates observed in previous trials on single OHA use, particularly metformin. Over the coming 5 years, clinical trial assessment will test the combined OHA hypothesis. Whether both OHA should be prescribed initially, with prudent progressive titrations, or one should be started with addition of the second if needed, remains a fascinating avenue for prospective research. Nonetheless, the question remains as to whether an oral agent, metformin or glyburide, is a better treatment option and if so, why.

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