Evidence-Based Treatment for a Patient with Gestational Diabetes Mellitus_Chinese Journal of Evidence-Based Medicine

Authors：

ZHANG Rong ,  XING Aiyun

Department of Obstetrics and Gynecology, West China Second Universary Hospital , Chengdu 610064, China;

Corresponding author：

XING Aiyun, Email: aiyun-x@126.com

Keywords：

Gestational Diabetes Mellitus; Metformin; Evidence-based Treatment

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Objective 　To formulate an evidence-based treatment plan for a patient with gestational diabetes mellitus. 　
Methods 　Based on the clinical questions raised from a real-life patient of gestational diabetes mellitus, we searched ACP Journal Club (1991 to Dec. 2006), The Cochrane Library (Issue 4, 2006), MEDLINE (1966 to Dec. 2006) and Chinese Biological Medical Database (1980 to Dec. 2006) for systematic reviews, randomized controlled trials, cohort and case-control studies. We used the following keywords: gestational diabetes, metformin, and pregnancy complication. The quality of the included studies was assessed.
Results 　One meta-analysis (from MEDLINE) and two randomized controlled trials (from the Cochrane Central Register of Controlled Trials) were included. These studies concluded that there was no clear evidence on the benefits of metformin for gestational diabetes. Based on the current evidence, integrated with clinical expertise and the patient’s values, metformin was not used for this patient. Instead, intensive dietary control, blood glucose control, and appropriate exercise were administered. After this individual treatment, the patient gave birth to a healthy baby in 39+4 Weeks.
Conclusion 　The appropriate management for gestational diabetes mellitus has been formulated with the approach of evidence-based medicine. Large-scale, methodologically-sound trials are required.

Citation： ZHANG Rong,XING Aiyun. Evidence-Based Treatment for a Patient with Gestational Diabetes Mellitus. Chinese Journal of Evidence-Based Medicine, 2007, 07(8): 614-617. doi: Copy

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1. Yue J, Editor-in-chief. Obstetrics and Gynecology. 6th ed. Beijing: People’s Medical Publishing House, 2004: 159-162.
2. Zhao RL. The Efficiency and Safty of Metformin used in Pregnancy women. Chin J Perinat Med, 2005, 8(5): 299.
3. 乐杰, 主编. 妇产科学. 第6版. 北京: 人民卫生出版社, 2004: 159-162.
4. 赵瑞琳. 二甲双胍治疗糖尿病孕妇的疗效及安全性——2005年美国糖尿病学会年会专题讨论侧记. 中华围产医学杂志, 2005, 8(5): 299.
5. Guyatt GH, Rennie D, Editors. The Evidence-Based Medicine Working Group. Users’ Guides to the Medical Literature: A Mannual for Evidence-Based Clinical Practice. Chicago: AMA Press, 2002.
6. Gilbert C, Valois M, Koren G, et al. Pregnancy outcome after first-trimester exposure to metformin: a meta-analysis. Fertil Steril, 2006, 86(3): 658-663.
7. Vanky E, Salvesen KA, Heimstad R, et al. Metformin reduces pregnancy complications without affecting androgen levels in pregnant polycystic ovary syndrome women: results of a randomized study. Hum Reprod, 2004, 19(8): 1734-1740.
8. Glueck CJ, Goldenberg N, Pranikoff J, et al. Height,weight,and motor-social development during the first 18 months of life in 126 infants born to 109 mothers with polycystic ovary syndrome who conceived on and continued metformin through pregnancy. Hum Reprod, 2004, 19(6): 1 323-1 330.
9. Simmons D, Waiters BN, Rowan JA, et al. Metformin therapy and diabetes in pregnancy. Med J, 2004, 180: 462-464.

Chinese Journal of Evidence-Based Medicine

Evidence-Based Treatment for a Patient with Gestational Diabetes Mellitus

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