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Brick by brick: metformin for gestational diabetes mellitus?
Jean-Luc Ardilouze1, Masoud Mahdavian1, Jean-Patrice Baillargeon1,2
1a Endocrine Division, Department of Medicine, University of Sherbrooke, 3001, 12ème avenue Nord, Sherbrooke, Québec, J1H 5N4, Canada.
Abstract:
Evaluation of: Balani J, Hyer SL, Rodin DA, Shehata H. Pregnancy outcomes in women with gestational diabetes treated with metformin or insulin: a case-control study. Diabet. Med. 26(8), 798-802 (2009). This paper reviews a case-control study, reported by Balani et al., comparing maternal and neonatal outcomes of women treated for gestational diabetes mellitus with either metformin or insulin. A cohort of 100 women treated with metformin alone, without insulin rescue, was compared with a retrospective cohort of 100 women treated with insulin. Results favored metformin. This paper discusses issues related to the safety and efficiency of metformin treatment during pregnancy, the attitudes of pregnant women toward treatment options, public health policy and the worldwide gestational diabetes mellitus epidemic, as well as the financial burden of therapy, particularly for developing countries. It also looks at the pathophysiology of gestational diabetes mellitus and the need for clinical trial assessment of combination oral-hypoglycemic therapy.
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