A claim you hear on longevity podcasts
The claim checked: For gestational diabetes, insulin does the most for the newborn Hear it at 33:55
One of ten studies favored insulin, and only against glyburide, another diabetes pill. Three found babies did better when the mother took metformin. They had fewer stays in newborn intensive care and fewer bouts of low blood sugar. Six found insulin and metformin about even, or mixed. Several found insulin did better than glyburide.
Computed from 10 studies that test this point, each judged by two readers, in full. 10 more studies are waiting for a full read and do not count yet.
“but really insulin is most um effective and we have good safety data and it has the best um influence on improving the neonatal outcomes.”
controlled trial · 2018
“The higher rate of the primary outcome in the glyburide group was mainly due to an increased rate of neonatal hypoglycemia.”
Effect of Glyburide vs Subcutaneous Insulin on Perinatal Complications Among Women With Gestational Diabetes: A Randomized Clinical Trial. JAMA
Who: women with singleton pregnancies and gestational diabetes diagnosed at 24-34 weeks who needed drug treatment after 10 days of diet, in 13 French university hospitals
PMID 29715355
pooled analysis · 2015 · landmark
“We conclude that, in the short term, in women with gestational diabetes requiring drug treatment, glibenclamide is clearly inferior to both insulin and metformin while metformin (plus insulin when required) performs slightly better than insulin.”
Glibenclamide, metformin, and insulin for the treatment of gestational diabetes: a systematic review and meta-analysis. BMJ
Who: Women with gestational diabetes requiring drug treatment in randomized controlled trials (US, Brazil, India, Australia/New Zealand, Finland, Iran)
PMID 25609400
pooled analysis · 2013
“In conclusion, metformin could be used in women with GDM in view of the comparative glycemic control and neonatal outcomes, especially for those mild GDM patients.”
Metformin vs insulin in the management of gestational diabetes: a meta-analysis. PLoS One
Who: women with GDM in 5 randomized controlled trials comparing metformin with insulin (USA, Australia/New Zealand, Finland, Iran)
PMID 23724063
pooled analysis · 2017
“Insulin and metformin have similar outcomes for mother and infant, however insulin does appear to have better outcomes than glibenclamide for reduced risk of being born large‐for‐gestational age (LGA) or macrosomic and reduced risk of neonatal hypoglycaemia.”
Insulin for the treatment of women with gestational diabetes. Cochrane Database Syst Rev
Who: Women with gestational diabetes in randomised trials comparing insulin with oral anti-diabetic drugs (metformin, glibenclamide, acarbose), non-drug care, or other insulin regimens; low-, middle- and high-income countries
PMID 29103210
pooled analysis · 2018
“Moderate-quality evidence showed no clear difference for insulin versus oral anti-diabetic pharmacological therapies.”
Treatments for women with gestational diabetes mellitus: an overview of Cochrane systematic reviews. Cochrane Database Syst Rev
Who: Women with gestational diabetes and their babies in RCTs from Cochrane reviews of GDM treatments (insulin vs oral therapy data from Brown 2017d)
PMID 30103263
pooled analysis · 2020
“Although limited suitable studies are available for inclusion in these meta-analyses, a clear picture emerges of babies exposed to glyburide being born larger and with increased adipose mass, and babies exposed to metformin being born smaller and with reduced lean mass, compared to those treated with standard insulin therapy.”
Comparative impact of pharmacological treatments for gestational diabetes on neonatal anthropometry independent of maternal glycaemic control: A systematic review and meta-analysis. PLoS Med
Who: pregnant women with gestational diabetes randomised to glyburide vs insulin (8 trials), metformin vs insulin (22 trials) or metformin vs glyburide (3 trials)
PMID 32442232
pooled analysis · 2014
“Between the two OADs studied in our meta-analysis, metformin seems to be superior to glyburide and an efficacious alternative to insulin therapy especially in patients with mild form of disease.”
Efficacy and safety of oral antidiabetic drugs in comparison to insulin in treating gestational diabetes mellitus: a meta-analysis. PLoS One
Who: Women with GDM needing drug therapy after diet failed, in RCTs of metformin or glyburide vs insulin
PMID 25302493
pooled analysis · 2017
“The results of the network meta-analysis ( figure 4 ) are consistent with the direct comparisons between treatments shown in figure 2A–H , suggesting that metformin is more effective than insulin or glibenclamide at reducing the majority of adverse outcomes.”
Treatments for gestational diabetes: a systematic review and meta-analysis. BMJ Open
Who: women with gestational diabetes or impaired glucose tolerance in randomised trials; 11 trials of metformin vs insulin, 9 of glibenclamide vs insulin, 3 of glibenclamide vs metformin
PMID 28647726
pooled analysis · 2019
“Risks of NICU admission and neonatal hypoglycemia were lower in the metformin group and reached a statistically significant level when compared with insulin (RR, 0.75; 95% CI, 0.64 to 0.87;”
Comparative Efficacy and Safety of Metformin, Glyburide, and Insulin in Treating Gestational Diabetes Mellitus: A Meta-Analysis. J Diabetes Res
Who: Women with gestational diabetes requiring drug treatment in randomized controlled trials comparing metformin, glyburide or insulin
PMID 31781670
other primary study · 2013
“NICU admission was more in the insulin group. (33 vs. 14) ( P = 0.002) main causes of hospitalization were hyper bilirubinemia in need of photo therapy, respiratory distress, and hypoglycemia.”
Comparison of newborn outcomes in women with gestational diabetes mellitus treated with metformin or insulin: a randomised blinded trial. Int J Prev Med
Who: Pregnant women aged 18-45 with a singleton pregnancy and gestational diabetes at 24-34 weeks not controlled by lifestyle change, at Shabih Khani hospital, Kashan, Iran
PMID 23626890
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