Therefore, the observed difference might have disappeared after the titration period of metformin, although no data were available to investigate this. Although dietary intervention is highly recommended, the clinical results of the widely prescribed diets with low fat content and high carbohydrates are disappointing.
The recently published A to Z trial showed that the most beneficial effect in weight reduction was in those patients treated with a carbohydrate-restricted diet in comparison with three other dietary interventions, lower in fat and higher in carbohydrates [ 6 ].
Benefits Both metformin and insulin help to normalize blood glucose levels. Patients were randomized to two doses of metformin, and parameters were assessed after 4 and 8 months.
Table 1 examines the weight changes in the groups treated with different doses of metformin, and it reveals that both treatment doses were associated with significant weight reductions over the 8-month assessment period.
The main reason for discontinuation was excessive gastrointestinal irritation. Because we aimed to assess the effect of metformin and insulin versus insulin alone irrespective of previous interventions, we included a diverse group of trials—for example, the percentage of patients who were insulin or metformin naive varied among trials.
First, the presence of GDM always accompanies an increased maternal risk for preeclampsia, cesarean section, and with an Comparison of insulin metformin and diet risk for developing type 2 diabetes T2D after pregnancy .
During the intervention no significant change of lipids was observed. The primary end point was weight loss, with the secondary intent to examine the effects of treatment or weight loss on cardiovascular risk factors, because these latter measures may be an important part of the case for extended use of oral antihyperglycemic medications in women with PCOS.
The diagnostic criterion was FPG concentration higher than 6. Within each BMI category, there was no difference between the dose subgroups for any parameter examined, whereas the differences between the Ob and Mob subgroups before treatment were in line with expected values.
Only the obese subgroup showed a dose relationship 1. There was no difference in age between the two groups.
The previous meta-analyses also included trials with high risk of bias and of short duration, similar to our systematic review. Glycemic index of carbohydrates is a strong determinant of HDL-cholesterol concentration in plasma [ 9 ].
A recent meta-analysis included a diverse group of trials of participants both with and without diabetes and showed a reduction of cardiovascular events with metformin not necessarily alone when compared with placebo, but, notably, not when compared with active comparators.
Likewise, HbA1c reductions were also more pronounced in trials using fixed insulin regimens than in those using variable regimens. No potential conflicts of interest relevant to this article are reported.
This trial was conducted in accordance with International Conference on Harmonization guidelines and the Declaration of Helsinki and Good Clinical Practice guidelines [ 16 ]. Suppression of androstenedione was significant with both metformin doses, but there was no clear dose relationship.
Purpose The purpose of both insulin and metformin is to lower blood glucose levels. Methods Patients A total of patients newly diagnosed as having type 2 diabetes, aged 25 to 65 years inclusive, were recruited between and in the first 15 UKPDS centers established.
After combining all the evidence available from randomised clinical trials, we were unable to find any evidence or even a trend towards improved all cause mortality or cardiovascular mortality with metformin and insulin, compared with insulin alone. After being selected, basic anthropometric measures, i.
Furthermore, the relationships between metformin and dose, and weight changes, endocrine changes, and cardiovascular risk factors such as lipid profiles 10 and C-reactive protein CRP 11 have only been sparsely examined.
The study included prospective cohorts randomized to two doses of metformin. Another major complication is macrosomia, which is a risk factor for instrumental delivery, cesarean section and shoulder dystocia during delivery and neonatal hypoglycemia directly after birth .
Patients were invited to return to the study center for follow-up visits after 1, 2, 3 and 6 months. Basic anamnestic questions regarding duration of diabetes and cardiovascular diseases were asked. This choice can only be better guided by randomised trials assessing patient relevant outcomes as well.
The authors have declared that no competing interests exist. Strengths and limitations Our systematic review has several strengths. After rejecting the reviews and screening the titles and abstracts, 6 trials involving GDM and metformin were assessed for eligibility.
Therefore, detailed guidance for dose change of insulin is necessary to ensure the safe self-administration of insulin.quantitative insulin-sensitivity check index and fasting glucose to insulin ratio were evaluated in each patient.
For comparison between the Metformin and diet groups before treat-ment and at 12 weeks of treatment, a two-tailed t-test was used for normally distributed variables. Women who are receiving insulin during the treatment are the control group; women who are receiving metformin, sometimes followed by insulin, are the experimental group.
Total number of women, age range, treatment time and testing methods are the same for both, control and experimental group. Hundred and ninety seven, 59% ofwomen believed that it was easier to take metformin rather than insulin, and35% of women believed that it was easier to take insulin.
At the end, researchers came to the conclusion that metformin is safer than insulin for mother and infants. Taking insulin without eating or taking too much insulin for the amount of food eaten can cause hypoglycemia. Symptoms of hypoglycemia include weakness, shakiness, sweating, lightheadedness and confusion; coma and death can result in severe cases.
Benefits. Both metformin and insulin help to normalize blood glucose levels. Galani V, Patel HM. Comparison of metformin and insulin monotherapy with combined metformin and insulin therapy in patients of type 2 diabetes with HbA1c > 7%.
Int J Pharmaceutical Biol Arch ; 2: The incidence of neonatal hypoglycemia was higher in the insulin group (52,4%) than in the metformin (33,3%) and diet group (17,6%), but there was statistically difference between insulin and diet.Download