Diet plus insulin compared to diet alone in the treatment of gestational diabetes mellitus: a systematic review

Diet plus insulin compared to diet alone in the treatment of gestational diabetes mellitus: a systematic review

Autor Giuffrida, Fernando de Mello Almada Autor UNIFESP Google Scholar
Castro, Aldemar Araujo Autor UNIFESP Google Scholar
Atallah, Álvaro Nagib Autor UNIFESP Google Scholar
Dib, Sergio Atala Autor UNIFESP Google Scholar
Instituição Universidade Federal de São Paulo (UNIFESP)
Resumo Fetuses of mothers with gestational diabetes mellitus are at increased risk to develop perinatal complications mainly due to macrosomia. However, in view of the marked heterogeneity of this disease, it seems difficult to set guidelines for diagnosis and treatment. This complicates the choice of assigning patients either to diet or to insulin therapy. Also of concern is how much benefit could be expected from insulin therapy in preventing fetal complications in these patients. In a systematic review of the literature assessing the efficacy of insulin in preventing macrosomia in fetuses of mothers with gestational diabetes, we found six randomized controlled trials comparing diet alone to diet plus insulin. The studies included a total of 1281 patients (644 in the diet plus insulin group and 637 in the diet group), with marked differences among trials concerning diagnostic criteria, randomization process and treatment goals. Meta-analysis of the data resulted in a risk difference of -0.098 (95%CI: -0.168 to -0.028), and a number-necessary-to-treat of 11 (95%CI: 6 to 36), which means that it is necessary to treat 11 patients with insulin to prevent one case of macrosomia. This indicates a potential benefit of insulin, but not significantly enough to set treatment guidelines. Because of the heterogeneous evidence available in the literature about this matter, we conclude that larger trials addressing the efficacy of these two therapeutic modalities in preventing macrosomia are warranted.
Assunto Diabetes
Gestational
Diet therapy
Fetal macrosomia
Insulin
Meta-analysis
Idioma Inglês
Data 2003-10-01
Publicado em Brazilian Journal of Medical and Biological Research. Associação Brasileira de Divulgação Científica, v. 36, n. 10, p. 1297-1300, 2003.
ISSN 0100-879X (Sherpa/Romeo, fator de impacto)
Editor Associação Brasileira de Divulgação Científica
Extensão 1297-1300
Fonte http://dx.doi.org/10.1590/S0100-879X2003001000004
Direito de acesso Acesso aberto Open Access
Tipo Artigo
Web of Science WOS:000185906900005
SciELO S0100-879X2003001000004 (estatísticas na SciELO)
URI http://repositorio.unifesp.br/handle/11600/1861

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