From: Reuters
Published May 7, 2008 07:44 PM

Pill effective against gestational diabetes

By Gene Emery

BOSTON (Reuters) - The diabetes pill metformin is just as effective as insulin injections in treating women who develop diabetes during pregnancy, researchers in New Zealand and Australia reported on Wednesday.

So-called gestational diabetes surfaces in one out of every 20 pregnant women, and there has been concern that metformin might affect a fetus because the drug can cross the placenta.

But the study, led by Janet Rowan of the Auckland City Hospital in New Zealand, found that the risk of complications such as respiratory distress, birth trauma and newborn hypoglycemia, or low blood sugar, was no different for the 363 women who received metformin and the 370 given conventional insulin shots.

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Metformin is available generically but also known by the Bristol-Myers Squibb brand name Glucophage.

After delivery, nearly 77 percent of the metformin recipients said they would want to stay with the pill if they developed diabetes during pregnancy again, even though 46 percent still needed supplemental insulin injections at some point.

Only 27 percent of those who got insulin shots felt the same way, they reported in the New England Journal of Medicine.

But doctors may still be cautious, the researchers said. "Clinicians may remain circumspect about using metformin until follow-up data for offspring are available," they wrote. The children born during the study are being tested when they reach their second birthday.

In a commentary, Drs. Jeffrey Ecker and Michael Greene of Harvard Medical School in Boston say one remaining question is whether metformin would be better than another generic pill, glyburide.

'MILD' GESTATIONAL DIABETES

Another study in Thursday's New England Journal of Medicine suggests that doctors may someday want to treat a rise in pregnancy-related blood sugar levels even more aggressively than they do now.

The test of 23,316 women in nine countries found having "mild" gestational diabetes, which usually is not treated, increased the risk for having a higher-weight baby and or a baby with high C-peptide levels, which measures the likelihood of diabetes.

For example, the risk of delivering a child whose weight was in the 90th percentile was 5 percent among the women with the lowest glucose levels, and at least 20 percent among women whose levels were highest.

The rate of Caesarean section also went up among women who were more likely to have higher glucose levels.

The team, led by Dr. Boyd Metzger of Northwestern University in Chicago, also found a link between blood sugar levels and problems such as premature delivery and birth injury, along with an increased likelihood that a newborn would end up in intensive care.

"These are well-recognized complications of pregnancies in mothers with preexisting or gestational diabetes, as currently defined," the researchers wrote.

But Ecker and Greene said it was unlikely definitions of what constitutes gestational diabetes would change.

(Editing by Maggie Fox and Eric Beech)

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