A Study Of Metformin Versus Insulin In The Management Of Diabetes Mellitus In Pregnancy At The Korle Bu Teaching Hospital

ABSTRACT Background: Diabetes mellitus is an important complication of pregnancy with adverse effects on both mother and fetus. Poor control of pre-gestational diabetes during the period of organogenesis increases the risk of major congenital malformations. While insulin is effective in controlling high blood glucose levels, otherwise resistant to diet and exercise management, several factors hinder its use. Metformin has been found to be a convenient, cheap, effective and safe hypoglycaemic agent in some countries. It is possible that metformin will have similar beneficial effects among Ghanaian pregnant women. Aim: The main aim of this study was to determine if either metformin monotherapy or metformin in combination with insulin is effective at glycaemic control compared to insulin monotherapy in the management of gestational diabetes mellitus and type 2 pre-gestational diabetes mellitus in Ghanaians. Methodology: This was a prospective randomized controlled study involving 104 pregnant women with T2DM or GDM at 20-30 weeks gestation. It was an opened labelled trial. Patient randomly assigned to one of the two treatment groups. Participants were followed through their index pregnancy with a 2-weekly glycaemic profile monitoring and maternal weight gain. Babies delivered were followed till the sixth week post-delivery, measuring birth weight, incidence of birth trauma and neonatal intensive care unit (NICU) admission rates. Both laboratory and clinical data were recorded and analyzed. Results: Ninety percent and 76% of participants in the metformin and insulin groups respectively completed the study. The 2HPG levels were significantly lower in the metformin group than the insulin group with p values of 0.004. The mean FBG and 1HPG levels from enrolment to term was comparable between the two treatment groups. The mean weight gain from randomization to term was significantly higher in the insulin group (4.46 ±2.09kg) than the metformin group (2.21 ±2.42kg) with p