Journal Reading

Could Metformin Manage

Gestational Diabetes Mellitus
instead of Insulin?

Hend S. Saleh, Walid A. Abdelsalam, Hala E.

Mowafy, and Azza A. Abd ElHameid

Fransiska Wibawa/ 406152045

Pembimbing : DR. dr. Cahyono Hadi, S.H., Sp.OG, (K)

RSUD RAA Soewondo, Pati
Journal Identity
Title
Could Metformin Manage Gestational Diabetes
Mellitus instead of Insulin?
Written by:
Hend S. Saleh, Walid A. Abdelsalam, Hala E. Mowafy,
and Azza A. Abd ElHameid
Published by:
Hindawi Publishing Corporation, International
Journal of Reproductive Medicine
Year:
2016
Could Metformin Manage Gestational Diabetes Mellitus instead of Insulin. International Journal of
Reproductive Medicine Vol 2016.

Introduction
Gestational diabetes mellitus (GDM) condition with
any level of glucose intolerance which began or was
detected for first time during pregnancy
Approximately 7% of pregnancies with an incidence of
more than 200,000 cases per year
Older and more obese pregnant women have the highest
incidence of GDM
Could Metformin Manage Gestational Diabetes Mellitus instead of Insulin. International Journal of
Reproductive Medicine Vol 2016.

Introduction
Extreme mother-to-fetus glucose transmit
augmented hazard for congenital defects,
neonatal death, and still birth
Macrosomia is an extra important complication
risk factor for instrumental delivery, shoulder
dystocia, and cesarean section during delivery
Could Metformin Manage Gestational Diabetes Mellitus instead of Insulin. International Journal of
Reproductive Medicine Vol 2016.

Introduction
The pharmacological interference subcutaneous
insulin or oral hypoglycaemic agents (metformin and
glyburide)
Insulin regimens intermediate acting insulin
(isophane) and short acting agents (regular recombinant
insulin/Humulin R)
Could Metformin Manage Gestational Diabetes Mellitus instead of Insulin. International Journal of
Reproductive Medicine Vol 2016.

Methods
prospective randomized comparative study
Inclusion criteria:
150 antenatal women with GDM did not
respond to diet modifications or nutritional
instructions alone in 3 weeks were recruited from
antenatal clinics at Obstetrics Department in
Zagazig University Hospitals from November 2012
to December 2014
GDM was diagnosed at 2634 weeks using WHO
criteria: fasting plasma glucose 126 mg/dL or 2-h
value > 140 mg/dL a 2-h 75 g OGTT
Could Metformin Manage Gestational Diabetes Mellitus instead of Insulin. International Journal of
Reproductive Medicine Vol 2016.

Methods
Exclusion criteria:
type 1 and type 2 diabetes on insulin treatment
fetal anomaly (USG)
hypersensitivity or intolerance to metformin
intake
any obstetric high risk conditions.
Could Metformin Manage Gestational Diabetes Mellitus instead of Insulin. International Journal of
Reproductive Medicine Vol 2016.

Methods
Group 1:
metformin orally at dose of 500 3000 mg/day
with meals till controlled glycemic profile was
realized.
Group 2:
insulin as a combination of short acting (Actrapid)
and intermediate acting (Mixtard) human insulin
as twice daily injections before breakfast and
before dinner
Could Metformin Manage Gestational Diabetes Mellitus instead of Insulin. International Journal of
Reproductive Medicine Vol 2016.

Insulin
0.6 units/kg body weight in 1st trimester,
0.7 units/kg body weight in 2nd trimester,
0.8 units/kg body weight from 28 to 32 weeks of
gestation,
0.9 units/kg body weight from 32 to 36 weeks of
gestation
1 unit/kg body weight from 36 weeks onwards
Could Metformin Manage Gestational Diabetes Mellitus instead of Insulin. International Journal of
Reproductive Medicine Vol 2016.

Methods
SPSS12.0
Qualitative analysis Two-sample independent
Students t-test and Mann-Whitney test
Quantitative analysis chi-square test Fisher
Exact test, and Mann-Whitney test
value of <0.05
Could Metformin Manage Gestational Diabetes Mellitus instead of Insulin. International Journal of
Reproductive Medicine Vol 2016.

Results
Prospective comparative study to compare the
usefulness of metformin versus human insulin in
patients with GDM
Could Metformin Manage Gestational Diabetes Mellitus instead of Insulin. International Journal of
Reproductive Medicine Vol 2016.
Could Metformin Manage Gestational Diabetes Mellitus instead of Insulin. International Journal of
Reproductive Medicine Vol 2016.
Could Metformin Manage Gestational Diabetes Mellitus instead of Insulin. International Journal of
Reproductive Medicine Vol 2016.
Could Metformin Manage Gestational Diabetes Mellitus instead of Insulin. International Journal of
Reproductive Medicine Vol 2016.
Could Metformin Manage Gestational Diabetes Mellitus instead of Insulin. International Journal of
Reproductive Medicine Vol 2016.
Could Metformin Manage Gestational Diabetes Mellitus instead of Insulin. International Journal of
Reproductive Medicine Vol 2016.

Discussion
The American College of Obstetricians and Gynecologists
(ACOG) does not support or recommend against the
use of oral antidiabetic agents in pregnancy
The United Kingdom National Institute for Health and
Clinical Excellence (NICE) recommends metformin
use before and during pregnancy and supports
metformin and glyburide for handling of gestational
diabetes
In the current study, we preferred using metformin as
one of the oral hypoglycemic medications.
Could Metformin Manage Gestational Diabetes Mellitus instead of Insulin. International Journal of
Reproductive Medicine Vol 2016.

Discussion
Coetzee and Jackson until Lim in 1997 GDM
can be managed efficiently and securely with
oral hypoglycemic drugs with no distinction in
pregnancy outcomes
Rowan et al. 2008 women with gestational
diabetes between 20 and 33 weeks of pregnancy
getting metformin or insulin there was no
difference in efficacy between both groups in
controlling glucose levels
Could Metformin Manage Gestational Diabetes Mellitus instead of Insulin. International Journal of
Reproductive Medicine Vol 2016.

Conclusion
Metformin is effective and safe in gestational
diabetes mellitus (GDM) and could be used
instead of insulin in such cases.
CRITICAL APPRISAL
Could Metformin Manage Gestational Diabetes Mellitus instead of Insulin. International Journal of
Reproductive Medicine Vol 2016.

Judul Jurnal

Judul 9 kata
Judul menggambarkan isi penelitian
Judul dibuat dengan kalimat yang sederhana
Tidak menggunakan singkatan
Could Metformin Manage Gestational Diabetes Mellitus instead of Insulin. International Journal of
Reproductive Medicine Vol 2016.

Abstrak

Mencakup komponen IMRD (Introduction, Methods, Result,

Discussion)
Jumlah kata : 191 kata kurang dari 250 kata
Could Metformin Manage Gestational Diabetes Mellitus instead of Insulin. International Journal of
Reproductive Medicine Vol 2016.

Pendahuluan
Terdiri dari 24 paragraf
Bagian pertama dan kedua mengemukakan
alasan dilakukan penelitian
Bagian ketiga mengemukakan tujuan
Didukung oleh pustaka yang relevan
Lebih dari 1 halaman
Hasil Penelitian
No. Kriteria Ya (+) Tidak (-)
1 Jumlah Subjek +
2 Tabel Karakteristik +
3 Tabel Hasil Penelitian +
4 Komentar dan Pendapat +
Penulis ttg hasil
Kesimpulan dan Daftar Pustaka
No. Kriteria Ya (+) Tidak (+)

1 Pembahasan dan kesimpulan +

terpisah
2 Pembahasan dan kesimpulan di +
paparkan dengan jelas
3 Pembahasan mengacu dari penelitian +
sebelumnya
4 Pembahasan sesuai dengan landasan +
teori
5 Keterbatasan Penelitian -
6 Simpulan berdasarkan penelitian +
7 Saran Penelitian -
8 Penulisan Daftar Pustaka sesuai +
aturan
Could Metformin Manage Gestational Diabetes Mellitus instead of Insulin. International Journal of
Reproductive Medicine Vol 2016.

PICO
Patient
Wanita hamil dengan GDM yang terdiagnosis saat
usia kehamilan 26-34 minggu dan tidak berespon
terhadap modifikasi makanan selama 3 minggu
Could Metformin Manage Gestational Diabetes Mellitus instead of Insulin. International Journal of
Reproductive Medicine Vol 2016.

PICO
Intervention
metformin (500 3000 mg/day)

Comparison
2 kali penyuntikan insulin kombinasi kerja pendek
(Actrapid) dan kerja sedang (Mixtard) per hari
Could Metformin Manage Gestational Diabetes Mellitus instead of Insulin. International Journal of
Reproductive Medicine Vol 2016.

PICO
Outcome
Tingkat keberhasilan dan efektivitas dalam
menurunkan gula darah puasa dan postprandial
Tingkat komplikasi dari GDM terhadap ibu dan
neonatus
 Bukti Valid
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Apakah pasien dan dokter tetap blind dalam
Tidak
melakukan terapi?
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terapi yang diuji?
 Applicability
APPLICABLE
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Tidak
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Terima kasih