Insulin plus metformin for gestational diabetes mellitus: impacts on blood glucose, coagulation function, and pregnancy outcomes.

OBJECTIVE: This retrospective study focused on the impacts of insulin plus metformin (MET) on blood glucose (BG), coagulation function, and pregnancy outcomes in patients with gestational diabetes mellitus (GDM). METHODS: The subjects were 129 GDM patients visiting The First Affiliated Hospital of Air Force Medical University, including 60 patients receiving insulin aspart (IA; control group) and 69 cases given MET+insulin aspart (observation group). General information and treatment outcomes were compared. Pre- and post-treatment BG (fasting plasma glucose [FPG], 2-hour postprandial plasma glucose [2hPG], glycosylated hemoglobin [HbA1c]), islet function (fasting insulin [FINS], Homeostasis Model Assessment-Insulin Resistance Index (HOMA-IR), HOMA-Beta Cell Function Index [HOMA-β]), coagulation function (activated partial thromboplastin time [APTT], prothrombin time [PT], thrombin time [TT]), adverse drug reactions, pregnancy outcomes, and fetal and neonatal conditions were compared between the two groups. Efficacy determinants were analyzed using univariate and multivariate methods. RESULTS: Compared to controls, MET+IA-treated patients showed superior curative effects, lower post-treatment BG indexes, FINS, and HOMA-IR, higher HOMA-β and various coagulation function parameters, as well as reduced rates of overall adverse pregnancy outcomes, total neonatal adverse events, and macrosomia. The groups were comparable in the adverse drug reaction rate. An abortion history increased the risk of ineffective treatment. CONCLUSION: Insulin+MET benefits BG control, coagulation function, and pregnancy outcomes in GDM patients.