Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC, USA.
Am J Perinatol. 2013 Jun;30(6):483-90. doi: 10.1055/s-0032-1326994. Epub 2012 Oct 24.
To compare the safety and tolerability of metformin to insulin for glycemic control among women with preexisting type 2 and early A2 gestational diabetes.
Women with preexisting type 2 diabetes and those diagnosed with gestational diabetes who required medical management prior to 20 weeks were randomly assigned to metformin or insulin. Glycemic control, defined as >50% capillary blood glucose within target range, was compared between groups. Other outcomes included patient tolerance, neonatal and obstetric complications, maternal weight gain, neonatal cord blood C-peptide, and patient satisfaction with therapy.
Twenty-eight women completed the study, with 14 in each group. Of the 15 women assigned to metformin, 100% continued to receive metformin until delivery, although 43% required supplemental insulin to achieve glycemic control. Glucose measures did not differ between the groups, and the proportion who met fasting and postprandial glycemic target values did not differ between the groups. Women treated with metformin had significantly fewer subjective episodes of hypoglycemia compared with those using insulin (0% versus 36%; p = 0.04) as well as reported glucose values < 60 mg/dL (7.1% versus 50%; p = 0.03).
Metformin should be considered for treatment of overt diabetes and early A2 gestational diabetes in pregnancy.
比较二甲双胍与胰岛素在控制血糖方面用于治疗有既往 2 型糖尿病和早期 A2 型妊娠期糖尿病的女性的安全性和耐受性。
将有既往 2 型糖尿病的女性和在 20 周前需要药物治疗的妊娠期糖尿病诊断患者随机分配至二甲双胍或胰岛素组。比较两组之间血糖控制情况（定义为>50%毛细血管血糖在目标范围内）。其他结局包括患者耐受性、新生儿和产科并发症、产妇体重增加、新生儿脐血 C 肽和患者对治疗的满意度。
28 名女性完成了研究，每组 14 名。在被分配至二甲双胍的 15 名女性中，尽管有 43%需要补充胰岛素以达到血糖控制，但 100%的女性继续接受二甲双胍治疗直至分娩。血糖测量值在两组之间没有差异，达到空腹和餐后血糖目标值的患者比例在两组之间也没有差异。与使用胰岛素的女性相比（0%与 36%；p = 0.04），使用二甲双胍的女性低血糖主观发作次数明显较少，并且报告的血糖值<60mg/dL（7.1%与 50%；p = 0.03）。
在妊娠期，应考虑将二甲双胍用于治疗显性糖尿病和早期 A2 型妊娠期糖尿病。
