, the Australasian Diabetes in Pregnancy Society (ADIPS) published guidelines for the management of gestational diabetes mellitus (GDM), which included a statement that “oral hypoglycaemic agents have no place in the treatment of GDM under normal circumstances”.1 Since then, there have been several published reports of the use of metformin during pregnancy, predominantly in women with polycystic ovary syndrome (PCOS).25 In addition, with the current epidemic of obesity and type 2 diabetes mellitus, an increasing number of women with diabetes are entering pregnancy and continuing to take metformin.6 GDM is also a common pregnancy complication in Australia, with a reported incidence in detailed surveys ranging from 5.5% to 8.8%.7 Doctors caring for women with diabetes in pregnancy are often asked about the safety and potential role of metformin treatment in pregnancy. ADIPS was asked to comment on this issue, so an ad hoc working party was formed and its recommendations circulated to the ADIPS committee, whose members represent the range of disciplines involved in the management of diabetes in pregnancy. The work involved a MEDLINE search (undertaken on 16 January 2004), using the terms “metformin” and “pregnancy”. Only human studies among women with diabetes were included. 12 they do not formally assess safety and effectiveness. Currently, metformin is classified as a Class C drug. This means that, while there is no evidence of teratogenesis or adverse fetal effects, insufficient data exist to state that harm does not occur.13 Metformin does cross the placenta, prompting a cautious approach to its use in pregnancy.14 Further, one retrospective study from 1970 reported an increase in perinatal losses and pre-eclampsia in a small cohort of metformin-treated women compared with women taking insulin or a sulfonylurea.15 However, the groups were not matched, with the metformin group mostly treated in the third trimester and having increased risk factors for pre-eclampsia. Metformin is an oral diabetes medicine that helps control blood sugar levels. Metformin is used together with diet and exercise to improve blood sugar control in adults with type 2 diabetes mellitus. Metformin is sometimes used together with insulin or other medications, but it is not for treating type 1 diabetes. You should not use metformin if you have severe kidney disease, metabolic acidosis, or diabetic ketoacidosis (call your doctor for treatment). If you need to have any type of x-ray or CT scan using a dye that is injected into your veins, you will need to temporarily stop taking metformin. Though extremely rare, you may develop lactic acidosis, a dangerous build-up of lactic acid in your blood. Call your doctor or get emergency medical help if you have unusual muscle pain, trouble breathing, stomach pain, dizziness, feeling cold, or feeling very weak or tired.
The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Know the risks and potential benefits of clinical studies and talk to your health care provider before participating. Listing a study does not mean it has been evaluated by the U. Although metformin has become a drug of choice for the treatment of type 2 diabetes mellitus, some patients may not receive it owing to the risk of lactic acidosis. Metformin, along with other drugs in the biguanide class, increases plasma lactate levels in a plasma concentration-dependent manner by inhibiting mitochondrial respiration predominantly in the liver. Elevated plasma metformin concentrations (as occur in individuals with renal impairment) and a secondary event or condition that further disrupts lactate production or clearance (e.g., cirrhosis, sepsis, or hypoperfusion), are typically necessary to cause metformin-associated lactic acidosis (MALA). As these secondary events may be unpredictable and the mortality rate for MALA approaches 50%, metformin has been contraindicated in moderate and severe renal impairment since its FDA approval in patients with normal renal function or mild renal insufficiency to minimize the potential for toxic metformin levels and MALA.
Metformin is now established as a first-line antidiabetic therapy for the management of type 2 diabetes. Its early use in treatment algorithms is supported by lack of weight gain, low risk of hypoglycaemia and its mode of action to counter insulin resistance. Feb 15, 2013 · Metformin’s negligible risk of hypoglycemia in monotherapy and few drug interactions of clinical relevance give this drug a high safety profile. introducing the need to evaluate the role of metformin as initial therapy and in combination with these newer drugs. an old but still the best treatment for type 2 diabetes. Lilian Beatriz.