Sun, 27 Jul 2008 07:27:37 BST CiteULike: omalbam's Gao http://www.citeulike.org/user/omalbam/author/Gao CiteULike.org en-gb Copyright © 2004-2008 citeulike.org http://www.citeulike.org/user/omalbam/article/2767857 <i>N Engl J Med, Vol. 358, No. 19. (8 May 2008), pp. 2003-2015.</i><br /><br />Background Metformin 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. Methods We 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. Results Of 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, 1.00; 95% confidence interval, 0.90 to 1.10). 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. Conclusions In 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.) 10.1056/NEJMoa0707193 Metformin versus Insulin for the Treatment of Gestational Diabetes Janet Rowan William Hague Wanzhen Gao Malcolm Battin Peter Moore The doi:10.1056/NEJMoa0707193 N Engl J Med, Vol. 358, No. 19. (8 May 2008), pp. 2003-2015. 2008-05-08T02:04:07-00:00 2008 N Engl J Med 358 19 2003 2015 diabetes metformin pregnancy therapy http://www.citeulike.org/user/omalbam/article/2330323 <i>Arch Intern Med, Vol. 167, No. 21. (26 November 2007), pp. 2310-2316.</i><br /><br />BACKGROUND: Much uncertainty exists about the role of dietary glycemic index and glycemic load in the development of type 2 diabetes mellitus, especially in populations that traditionally subsist on a diet high in carbohydrates. METHODS: We observed a cohort of 64,227 Chinese women with no history of diabetes or other chronic disease at baseline for 4.6 years. In-person interviews were conducted to collect data on dietary habits, physical activity, and other relevant information using a validated questionnaire. Incident diabetes cases were identified via in-person follow-up. Associations between dietary carbohydrate intake, glycemic index, and glycemic load and diabetes incidence were evaluated using multivariable Cox proportional hazards models. RESULTS: We identified 1,608 incident cases of type 2 diabetes mellitus in 297,755 person-years of follow-up. Dietary carbohydrate intake and consumption of rice were positively associated with risk of developing type 2 diabetes mellitus. The multivariable-adjusted estimates of relative risk comparing the highest vs the lowest quintiles of intake were 1.28 (95% confidence interval, 1.09-1.50) for carbohydrates and 1.78 (95% confidence interval, 1.48-2.15) for rice. The relative risk for increasing quintiles of intake was 1.00, 1.04, 1.02, 1.09, and 1.21 (95% confidence interval, 1.03-1.43) for dietary glycemic index and 1.00, 1.06, 0.97, 1.23, and 1.34 (95% confidence interval, 1.13-1.58) for dietary glycemic load. CONCLUSION: High intake of foods with a high glycemic index and glycemic load, especially rice, the main carbohydrate-contributing food in this population, may increase the risk of type 2 diabetes mellitus in Chinese women. Prospective study of dietary carbohydrates, glycemic index, glycemic load, and incidence of type 2 diabetes mellitus in middle-aged Chinese women. R Villegas S Liu YT Gao G Yang H Li W Zheng XO Shu doi:10.1001/archinte.167.21.2310 Arch Intern Med, Vol. 167, No. 21. (26 November 2007), pp. 2310-2316. 2008-02-04T18:47:02-00:00 2007 Arch Intern Med 0003-9926 167 21 2310 2316 diabetes diet risk