Rawat Dimple, Gupta Yashdeep, Yadav Arun Kumar, Tembhre Manoj Kumar, Das Priyanka, Bakkireddy Saisree, Singh Neeta, Sharma K Aparna, Zangmo Rinchen, Chandra Avdhesh, Upadhyay Ashish Datt, Garg Deepali
Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences (AIIMS), New Delhi, India.
Department of Endocrinology, Metabolism and Diabetes, All India Institute of Medical Sciences (AIIMS), New Delhi, India.
Diabetes Metab Syndr. 2024 Sep;18(9):103134. doi: 10.1016/j.dsx.2024.103134. Epub 2024 Oct 9.
Gestational diabetes mellitus (GDM) is commonly managed with either metformin or insulin, but their comparative effects on offspring cardiometabolic outcomes are not fully understood.
To investigate the impact of metformin and insulin, two distinct pharmacological interventions, on cardiometabolic outcomes in offspring of mothers with GDM.
Systematic literature review was performed for articles (randomized control trials) published from 1974 to May 2024 using a predefined search strategy. Studies were screened for title and abstract followed by full text. Quality assessment was done using a separate risk of bias tool in line with the PRISMA-2020 checklist.
Among 5463 records, five studies (metformin = 409 children or insulin n = 434 children) were included. Offspring of metformin-treated mothers in the age range of 5-9 years had more fat-free mass (kg) by bioimpedance and abdominal (subcutaneous and visceral) fat volume (cm) by MRI. Fasting plasma glucose and triglycerides were lower in the metformin-treated group for offspring aged 5-9 years. No significant differences were observed for other cardiometabolic outcomes. Limited data available for offsprings less than 5 years of age precluded meta-analysis for the available outcomes, except for body weight, and difference for this was also not significant.
In short term no major differences has been seen in most of the cardiometabolic outcomes evaluated in the meta-analysis. Future trials with longer follow up are required and in different ethnicities.
PROSPERO-CRD42023450990.
妊娠糖尿病（GDM）通常采用二甲双胍或胰岛素进行治疗，但其对后代心脏代谢结局的比较效果尚未完全明确。
探讨二甲双胍和胰岛素这两种不同的药物干预措施对GDM母亲后代心脏代谢结局的影响。
采用预定义的检索策略，对1974年至2024年5月发表的文章（随机对照试验）进行系统文献综述。先对标题和摘要进行筛选，然后进行全文筛选。根据PRISMA - 2020清单，使用单独的偏倚风险工具进行质量评估。
在5463条记录中，纳入了五项研究（二甲双胍组 = 409名儿童，胰岛素组 = 434名儿童）。接受二甲双胍治疗的母亲的5至9岁后代通过生物电阻抗法测得的去脂体重（kg）更多，通过磁共振成像测得的腹部（皮下和内脏）脂肪体积（cm）更大。5至9岁后代的二甲双胍治疗组空腹血糖和甘油三酯较低。其他心脏代谢结局未观察到显著差异。5岁以下后代的可用数据有限，除体重外，无法对可用结局进行荟萃分析，且体重差异也不显著。
短期内，荟萃分析评估的大多数心脏代谢结局未见重大差异。需要开展随访时间更长且针对不同种族的未来试验。
PROSPERO - CRD42023450990。
