Effectiveness of Metformin Compared to Insulin in Pregnant Women With Mild Preexisting or Early Gestational Diabetes (MIPOD)
21 avril 2017 mis à jour par: University of North Carolina, Chapel Hill
Pilot Study of Metformin vs. Insulin in Pregnant Overt Diabetics (MIPOD)
Many women come into pregnancy with diabetes that is controlled with either Metformin or diet control; however, the current standard of care for the treatment of preexisting diabetes in pregnancy is insulin. Metformin is widely used in the non-pregnant population for glycemic control, and has been used in pregnancy for other indications without adverse maternal or fetal outcomes. What remains unproven is the ability of Metformin to adequately control glucose in women during pregnancy.
Our goal is to randomize 100 women who enter pregnancy with diabetes that is controlled by either diet or an oral agent and women who are found to have an abnormal glucose challenge test at less than 20 weeks to either standard treatment with weight based Regular and neutral protamine Hagedorn (NPH) insulin or Metformin. Our hypothesis is that Metformin will provide glycemic control that is equivalent to insulin in these women.
Aperçu de l'étude
Statut
Complété
Les conditions
Intervention / Traitement
Type d'étude
Interventionnel
Inscription (Réel)
31
Phase
- Phase 2
Contacts et emplacements
Cette section fournit les coordonnées de ceux qui mènent l'étude et des informations sur le lieu où cette étude est menée.
Lieux d'étude
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North Carolina
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Chapel Hill, North Carolina, États-Unis, 27599
- University of North Carolina Hospitals Obstetric Clinics
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Critères de participation
Les chercheurs recherchent des personnes qui correspondent à une certaine description, appelée critères d'éligibilité. Certains exemples de ces critères sont l'état de santé général d'une personne ou des traitements antérieurs.
Critère d'éligibilité
Âges éligibles pour étudier
18 ans et plus (Adulte, Adulte plus âgé)
Accepte les volontaires sains
Non
Sexes éligibles pour l'étude
Femelle
La description
Inclusion Criteria:
- Receiving prenatal care at University of North Carolina (UNC), Chapel Hill Obstetric clinics and planning delivery at UNC Women's Hospital
- Diagnosis of Diabetes prior to pregnancy with use of an oral hypoglycemic agent or dietary control
- Diagnosis of early gestational diabetes prior to 20 weeks gestation via abnormal 3 hour glucose challenge testing using the national diabetes data group (NDDG)criteria
- Less than 24 weeks at study enrollment
- Singleton or twin pregnancy
- English or Spanish speaking
- Able to give informed consent
Exclusion Criteria:
- End organ complications of diabetes (retinopathy, renal insufficiency, etc.)
- Prior need for insulin for glycemic control
- History of diabetic ketoacidosis (DKA) or hyperosmolar state
- Prior adverse reaction (ie. lactic acidosis) or allergy to Metformin
- Kidney or liver disease
- Significant medical co-morbidities (lupus, cystic fibrosis, etc.) Hypertension controlled on one medication, well controlled asthma, and well controlled thyroid disease are not excluded.
Plan d'étude
Cette section fournit des détails sur le plan d'étude, y compris la façon dont l'étude est conçue et ce que l'étude mesure.
Comment l'étude est-elle conçue ?
Détails de conception
- Objectif principal: Traitement
- Répartition: Randomisé
- Modèle interventionnel: Affectation parallèle
- Masquage: Aucun (étiquette ouverte)
Armes et Interventions
Groupe de participants / Bras |
Intervention / Traitement |
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Expérimental: Metformin
Women who enter pregnancy with a diagnosis of non insulin dependent/Type 2 Diabetes that is controlled with diet or an oral hypoglycemic agent, and women who demonstrate abnormal glucose tolerance prior to 20 weeks of gestation by abnormal 3 hour glucose challenge testing will be offered study participation.
After informed consent, they will be randomized 1:1 to either the Metformin or Insulin group.
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Women randomized to the Experimental arm will receive standard diet and glucose self-monitoring education.
They will be initiated on Metformin 500 BID if they were medication naïve, or will be continued on their current dosage of Metformin if they were taking it prior to pregnancy.
At each clinic visit fasting and one hour post prandial glucose values will be reviewed, and dosage will be titrated to a maximum of 2250mg/day to achieve target glycemic control.
If glycemic control can not be achieved with Metformin as a single agent insulin will be added.
Autres noms:
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Comparateur actif: Insulin
Women who enter pregnancy with a diagnosis of non insulin dependent/Type 2 Diabetes that is controlled with diet or an oral hypoglycemic agent, and women who demonstrate abnormal glucose tolerance prior to 20 weeks of gestation by abnormal 3 hour glucose challenge testing will be offered study participation.
After informed consent, they will be randomized 1:1 to either the Metformin or Insulin group.
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Women randomized to the Insulin group will receive standard diet and glycemic monitoring education.
They will be initiated on weight based Regular and NPH insulin at a total dosage of 0.7units/kg in the first trimester or 0.8units/kg in the second trimester divided as 2/3 of the total dosage (with 2/3 given as NPH and 1/3 given as Regular) administered before breakfast and 1/3 of the total dosage (with 1/2 given as NPH and 1/2 given as Regular)administered with dinner.
At each clinic visit fasting and one hour post prandial glucose values will be reviewed, and dosage will be titrated to achieve optimal glycemic control with fasting values <90 and one hour post prandial values <130.
Autres noms:
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Que mesure l'étude ?
Principaux critères de jugement
Mesure des résultats |
Description de la mesure |
Délai |
|---|---|---|
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Blood Glucose Measurements
Délai: Daily fasting and 1-hr post prandial measures were taken from time of enrollment until delivery
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Patients self monitored glucose measures throughout pregnancy to aid glycemic control.
Fasting morning measures and postprandial measures were taken at 1 hour after breakfast, lunch, and dinner.
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Daily fasting and 1-hr post prandial measures were taken from time of enrollment until delivery
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Mesures de résultats secondaires
Mesure des résultats |
Description de la mesure |
Délai |
|---|---|---|
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Number of Patients With Obstetric Complications
Délai: Throughout pregnancy until hospital discharge following delivery.
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Maternal complications were stillbirths, major malformations, shoulder dystocia, or postpartum hemorrhage requiring transfusion.
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Throughout pregnancy until hospital discharge following delivery.
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Maternal Weight Gain
Délai: Baseline throughout pregnancy until last prenatal visit.
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Baseline throughout pregnancy until last prenatal visit.
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Number of Babies With Neonatal Hypoglycemia
Délai: Time of delivery through hospital discharge
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Initial neonatal glucose < 40 mg/dL
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Time of delivery through hospital discharge
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Glycosylated Hemoglobin (HbA1c) by Pregnancy Trimester
Délai: 1st, 2nd, and 3rd trimester
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1st, 2nd, and 3rd trimester
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Percent of Glucose Values at or Below Fasting Goal (<95 mg/dL)
Délai: Baseline throughout pregnancy until time of delivery
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NUMBER OF ASSESSMENTS OF FASTING GLUCOSE VALUES <95
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Baseline throughout pregnancy until time of delivery
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Percent of Glucose Values at or Below Postprandial Goal (<130 mg/dL)
Délai: Baseline throughout pregnancy until time of delivery
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NUMBER OF ASSESSMENTS OF POSTPRANDIAL GLUCOSE VALUES <130
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Baseline throughout pregnancy until time of delivery
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Number of Episodes Maternal Hypoglycemia
Délai: Baseline throughout pregnancy until time of delivery
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Maternal glucose < 60 mg/dL
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Baseline throughout pregnancy until time of delivery
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Number of Babies With Adverse Neonatal Outcomes
Délai: Delivery until hospital discharge
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Resuscitation in the delivery room, preterm birth < 37 weeks, neonatal intensive care unit care, birth injury or diagnosis of neonatal complication, glucose infusion, antibiotics, or phototherapy.
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Delivery until hospital discharge
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Collaborateurs et enquêteurs
C'est ici que vous trouverez les personnes et les organisations impliquées dans cette étude.
Collaborateurs
Les enquêteurs
- Chercheur principal: Ashley Hickman, MD, University of North Carolina, Chapel Hill
Publications et liens utiles
La personne responsable de la saisie des informations sur l'étude fournit volontairement ces publications. Il peut s'agir de tout ce qui concerne l'étude.
Dates d'enregistrement des études
Ces dates suivent la progression des dossiers d'étude et des soumissions de résultats sommaires à ClinicalTrials.gov. Les dossiers d'étude et les résultats rapportés sont examinés par la Bibliothèque nationale de médecine (NLM) pour s'assurer qu'ils répondent à des normes de contrôle de qualité spécifiques avant d'être publiés sur le site Web public.
Dates principales de l'étude
Début de l'étude
1 août 2008
Achèvement primaire (Réel)
1 février 2010
Achèvement de l'étude (Réel)
1 avril 2010
Dates d'inscription aux études
Première soumission
2 février 2009
Première soumission répondant aux critères de contrôle qualité
2 février 2009
Première publication (Estimation)
4 février 2009
Mises à jour des dossiers d'étude
Dernière mise à jour publiée (Réel)
25 avril 2017
Dernière mise à jour soumise répondant aux critères de contrôle qualité
21 avril 2017
Dernière vérification
1 avril 2014
Plus d'information
Termes liés à cette étude
Mots clés
Termes MeSH pertinents supplémentaires
Autres numéros d'identification d'étude
- UNC08-0898
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