Evidence map›Paper›PMID 18463376›Full record

Trial reportThe New England journal of medicine2008

Metformin versus insulin for the treatment of gestational diabetes.

Janet A Rowan, William M Hague, Wanzhen Gao, Malcolm R Battin, M Peter Moore, MiG Trial Investigators

Erratum issued 8 registry-linked trialsAbstract readComparative StudyMulticenter StudyRandomized Controlled Trial
PubMed Publisher
In one paragraph

Trial report in The New England journal of medicine, 2008. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. It is linked to 8 registered trials, which are not on this map. Cited by 345 papers, 14 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
345citing papers in PubMed, 14 pooled it
59.2field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT01273584 phase2 / phase3completedstarted 2010, after this paper: background citation

Does Metformin Improve Pregnancy Outcomes (Incidence of LGA (≥90% Birth Weight Centile) Babies, Onset of Maternal GDM, Hypertension, PET, Macrosomia, Shoulder Dystocia, Admission to SCBU) in Obese Non-diabetic Women?

Ran2010Enrolled450Registered outcomes17Posted comparisons0ConditionsObesity, Pregnancy ComplicationsArmsMetformin, Placebo
PMID 14998944PMID 10799397PMID 19709150PMID 17434869other papers from this trial
Open the trial in the graph
NCT01998113 completedstarted 2013, after this paper: background citation

Glyburide and Metformin for the Treatment of Gestational Diabetes Mellitus. A Systematic Review and Meta-analysis of Randomized Controlled Trials Comparing These Drugs Either vs Insulin or vs Each Other.

Ran2013Enrolled2,509Registered outcomes30Posted comparisons0ConditionsGestational Diabetes MellitusArmsGlyburide vs Insulin trials, Metformin vs Glyburide trials, Metformin vs Insulin trials
PMID 11036118PMID 23724063PMID 22505499PMID 20739011PMID 19104375other papers from this trial
Open the trial in the graph
NCT02394158 phase4unknown statusstarted 2015, after this paper: background citation

Preventing Recurrent Gestational Diabetes Mellitus With Early Metformin Intervention

Ran2015Enrolled112Registered outcomes11Posted comparisons0ConditionsGestational Diabetes MellitusArmsMetformin, Placebo
PMID 21530058PMID 18463375PMID 22596383PMID 20630491other papers from this trial
Open the trial in the graph
NCT06064669 narecruitingstarted 2024, after this paper: background citation

Effect of Metformin on Healthy Live Birth After In-vitro Fertilization in Women With Prediabetes Mellitus: a Multicenter Double-blind Placebo Controlled Randomized Trial

Ran2024Enrolled988Registered outcomes26Posted comparisons0ConditionsIn-Vitro Fertilization, Metformin, PrediabetesArmsMetformin pretreatment before endometrial preparation for frozen embryo transfer, Metformin pretreatment before ovarian stimulation, Placebo pretreatment before endometrial preparation for frozen embryo transfer, Placebo pretreatment before ovarian stimulation
PMID 34281467PMID 25945500PMID 29045765PMID 18826999PMID 11832527PMID 31845767PMID 32215823PMID 32556707PMID 32578220PMID 32736942PMID 32744629PMID 32810195other papers from this trial
Open the trial in the graph
NCT03380546 phase3terminatednot on this mapstarted 2018, after this paper: background citation

Non-inferiority Between Acarbose and Prandial Insulin for the Treatment of Gestational Diabetes Mellitus: a Randomized Multicenter and Prospective Trial. ACARB-GDM Study.

TypeinterventionalSponsorAssistance Publique - Hôpitaux de ParisRan2018 to 2024Enrolled341ConditionsGestational Diabetes Mellitus in PregnancyArmsAcarbose, Prandial insulin
NCT04855513 naunknown statusnot on this mapstarted 2022, after this paper: background citation

Prevention of Pre-eclampsia Using Metformin: a Randomized Control Trial

TypeinterventionalSponsorHamad Medical CorporationRan2022 to 2023Enrolled414ConditionsPreeclampsia, Preeclampsia Severe, High Risk Pregnancy, EclampsiaArmsMetformin
NCT06359015 phase4terminatednot on this mapstarted 2021, after this paper: background citation

Use of Combination Metformin and Esomeprazole in Preterm Pre-eclampsia: a Randomized Controlled Trial

TypeinterventionalSponsorChristiana Care Health ServicesRan2021 to 2025Enrolled4ConditionsPreeclampsia Severe, Pre-Eclampsia, Preeclampsia, Preeclampsia Second TrimesterArmsMetformin, Esomeprazole
NCT06611501 phase2active not recruitingnot on this mapstarted 2025, after this paper: background citation

Glycemic Regulation as Endometriosis Adjunct Treatment

TypeinterventionalSponsorBoston Children's HospitalRan2025 to 2027Enrolled14ConditionsPelvic Pain, EndometriosisArmsMetformin Hydrochloride, Placebo
3 · Its place in the literature

Who cites it

345 citing papers in PubMed, 14 syntheses or guidelines pooled it, 1,273 citations in OpenAlex.

  1. Pooled it
  2. Metformin + Insulin vs. Insulin for GDM and T2DM during pregnancy: systematic review and meta-analysis.Revista brasileira de ginecologia e obstetricia : revista da Federacao Brasileira das Sociedades de Ginecologia e Obstetricia · 2026 · on this map
    Pooled it
  3. Pooled it
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  5. Guideline
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  9. American Association of Clinical Endocrinology Clinical Practice Guideline: Developing a Diabetes Mellitus Comprehensive Care Plan-2022 Update.Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists · 2022
    Guideline
  10. Pooled it
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  14. Evaluation of Preeclampsia Results after Use of Metformin in Gestation: Systematic Review and Meta-analysis.Revista brasileira de ginecologia e obstetricia : revista da Federacao Brasileira das Sociedades de Ginecologia e Obstetricia · 2018
    Pooled it
  15. Trial
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285 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

6 authors at 5 institutions in 2 countries.

Janet A RowanNational Women's Health, Auckland City Hospital, Grafton, Auckland, New Zealand. jrowan@internet.co.nz
William M Hague
Wanzhen Gao
Malcolm R Battin
M Peter Moore
MiG Trial Investigators
Auckland City Hospital · NZAuckland University of Technology · NZChristchurch Hospital · NZThe University of Adelaide · AUUniversity of Auckland · NZ

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundMetformin is a logical treatment for women with gestational diabetes mellitus, but randomized trials to assess the efficacy and safety of its use for this condition are lacking.

methodsWe randomly assigned 751 women with gestational diabetes mellitus at 20 to 33 weeks of gestation to open treatment with metformin (with supplemental insulin if required) or insulin. The primary outcome was a composite of neonatal hypoglycemia, respiratory distress, need for phototherapy, birth trauma, 5-minute Apgar score less than 7, or prematurity. The trial was designed to rule out a 33% increase (from 30% to 40%) in this composite outcome in infants of women treated with metformin as compared with those treated with insulin. Secondary outcomes included neonatal anthropometric measurements, maternal glycemic control, maternal hypertensive complications, postpartum glucose tolerance, and acceptability of treatment.

resultsOf the 363 women assigned to metformin, 92.6% continued to receive metformin until delivery and 46.3% received supplemental insulin. The rate of the primary composite outcome was 32.0% in the group assigned to metformin and 32.2% in the insulin group (relative risk, 0.99 [corrected]; 95% confidence interval, 0.80 [corrected] to 1.23 [corrected]). More women in the metformin group than in the insulin group stated that they would choose to receive their assigned treatment again (76.6% vs. 27.2%, P<0.001). The rates of other secondary outcomes did not differ significantly between the groups. There were no serious adverse events associated with the use of metformin.

conclusionsIn women with gestational diabetes mellitus, metformin (alone or with supplemental insulin) is not associated with increased perinatal complications as compared with insulin. The women preferred metformin to insulin treatment. (Australian New Zealand Clinical Trials Registry number, 12605000311651.).

Indexed as

Pregnancy OutcomeAdultDiabetes, GestationalDrug Therapy, CombinationFemaleGestational AgeHumansHypoglycemiaHypoglycemic AgentsInfant, NewbornInsulinJaundice, NeonatalMetforminPatient SatisfactionPregnancyPregnancy Complications, CardiovascularHypoglycemic AgentsInsulinMetformin

Identifiers

PMID18463376
OpenAlexW2003621575

What Socratic holds

Textmetadata
Read underepoch 390

Registered trials

and 2 more above

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.