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

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dc.contributor.authorGiuffrida, Fernando de Mello Almada [UNIFESP]
dc.contributor.authorCastro, Aldemar Araujo [UNIFESP]
dc.contributor.authorAtallah, Álvaro Nagib [UNIFESP]
dc.contributor.authorDib, Sergio Atala [UNIFESP]
dc.contributor.institutionUniversidade Federal de São Paulo (UNIFESP)
dc.date.accessioned2015-06-14T13:30:08Z
dc.date.available2015-06-14T13:30:08Z
dc.date.issued2003-10-01
dc.description.abstractFetuses 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.en
dc.description.affiliationUniversidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Departamento de Medicina
dc.description.affiliationUnifespUNIFESP, EPM, Depto. de Medicina
dc.description.sourceSciELO
dc.format.extent1297-1300
dc.identifierhttp://dx.doi.org/10.1590/S0100-879X2003001000004
dc.identifier.citationBrazilian Journal of Medical and Biological Research. Associação Brasileira de Divulgação Científica, v. 36, n. 10, p. 1297-1300, 2003.
dc.identifier.doi10.1590/S0100-879X2003001000004
dc.identifier.fileS0100-879X2003001000004.pdf
dc.identifier.issn0100-879X
dc.identifier.scieloS0100-879X2003001000004
dc.identifier.urihttp://repositorio.unifesp.br/handle/11600/1861
dc.identifier.wosWOS:000185906900005
dc.language.isoeng
dc.publisherAssociação Brasileira de Divulgação Científica
dc.relation.ispartofBrazilian Journal of Medical and Biological Research
dc.rightsinfo:eu-repo/semantics/openAccess
dc.subjectDiabetesen
dc.subjectGestationalen
dc.subjectDiet therapyen
dc.subjectFetal macrosomiaen
dc.subjectInsulinen
dc.subjectMeta-analysisen
dc.titleDiet plus insulin compared to diet alone in the treatment of gestational diabetes mellitus: a systematic reviewen
dc.typeinfo:eu-repo/semantics/article
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