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CC BY 4.0 · Rev Bras Ginecol Obstet 2019; 41(12): 697-702
DOI: 10.1055/s-0039-1700796
Original Article
Thieme Revinter Publicações Ltda Rio de Janeiro, Brazil

Factors Associated with the Need for Insulin as a Complementary Treatment to Metformin in Gestational Diabetes Mellitus

Fatores associados à necessidade de insulina como tratamento complementar à metformina na diabetes mellitus gestacional
Matheus Leite Ramos de Souza 
1   Department of Medicine, Universidade da Região de Joinville, Joinville, SC, Brazil
,
Rodrigo Ribeiro e Silva
1   Department of Medicine, Universidade da Região de Joinville, Joinville, SC, Brazil
,
Thiago Ribeiro e Silva
2   Department of Medicine, Universidade Positivo, Curitiba, PR, Brazil
,
Larissa Cano de Oliveira
1   Department of Medicine, Universidade da Região de Joinville, Joinville, SC, Brazil
,
Guilherme Dienstmann
1   Department of Medicine, Universidade da Região de Joinville, Joinville, SC, Brazil
,
Iramar Baptistella do Nascimento
1   Department of Medicine, Universidade da Região de Joinville, Joinville, SC, Brazil
,
Jean Carl Silva
1   Department of Medicine, Universidade da Região de Joinville, Joinville, SC, Brazil
› Author Affiliations Funding The present research did not receive any specific grant or funding from agencies in the public, private, or not-for-profit sectors.
Further Information

Publication History

07 June 2019

09 September 2019

Publication Date:
19 December 2019 (online)

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Abstract

Objective To evaluate the factors associated with the need for insulin as a complementary treatment to metformin in pregnant women with gestational diabetes mellitus (GDM).

Methods A case-control study was performed from April 2011 to February 2016 with pregnant women with GDM who needed complementary treatments besides diet and physical exercise. Those treated with metformin were compared with those who, in addition to metformin, also needed the combination with insulin. Maternal characteristics and glycemic control were evaluated. Multinomial logistic regression models were developed to evaluate the influence of different therapies on neonatal outcomes.

Results A total of 475 pregnant women who needed pharmacological therapy were evaluated. Of these, 366 (77.05%) were submitted to single therapy with metformin, and 109 (22.94%) needed insulin as a complementary treatment. In the analysis of the odds ratio (OR), fasting glucose (FG) < 90 mg/dL reduced the odds of needing the combination (OR: 0.438 [0.235–0.815]; p = 0.009], as well as primiparity (OR: 0.280 [0.111–0.704]; p = 0.007]. In obese pregnant women, an increased chance of needing the combination was observed (OR: 2,072 [1,063–4,039]; p = 0,032).

Conclusion Obesity resulted in an increased chance of the mother needing insulin as a complementary treatment to metformin, while FG < 90 mg/dL and primiparity were protective factors.

Resumo

Objetivo Avaliar os fatores associados à necessidade de insulina como tratamento complementar à metformina em gestantes com diabetes mellitus gestacional (DMG).

Métodos Um estudo caso-controle foi realizado de abril de 2011 a fevereiro de 2016 com gestantes portadoras de DMG que necessitaram de tratamentos complementares além de dieta e exercícios físicos. Aquelas tratadas com metformina foram comparadas com aquelas que, além da metformina, também precisaram de combinação com insulina. Foram avaliadas as características maternas e de controle glicêmico. Modelos de regressão logística multinomial foram construídos para avaliar a influência das diferentes terapias nos desfechos neonatais.

Resultados Foram avaliadas 475 gestantes que necessitaram de terapia farmacológica. Destas, 366 (77,05%) utilizaram terapia única com metformina, e 109 (22,95%) necessitaram de insulina como tratamento complementar. Na análise da razão de possibilidades (RP), a glicemia de jejum (GJ) < 90 mg/dL reduziu as chances de necessidade da combinação (RP: 0,438 [0,235–0,815]; p = 0,009), bem como a primiparidade (RP: 0,280 [0,111–0,704]; p = 0,007). Em gestantes obesas, foi observada uma chance maior de necessidade da combinação (RP: 2.072 [1.063–4.039]; p = 0,032).

Conclusão A obesidade resultou em um aumento na chance de a mãe precisar de insulina como tratamento complementar à metformina, enquanto a GJ < 90 mg/dL e a primiparidade foram fatores de proteção.

Keywords

gestational diabetes - metformin - insulin - combined treatment

Palavras-chave

diabetes gestacional - metformina - insulina - tratamento combinado
 

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