SUN-533 - In Patients with Gestational Diabetes Mellitus, Is Acarbose Effective in Achieving Similar Glycemic Control Compared to That of Insulin Therapy?

Background: Gestational diabetes mellitus (GDM) is one of the most common medical complications during pregnancy. If not properly managed, GDM increases the risk of adverse maternal and perinatal outcomes. Lifestyle modifications are a key part of managing GDM. However, if lifestyle modification have been done but yet glycemic goals are not achieved, then pharmacologic therapy is initiated. Insulin has been the gold standard treatment in GDM due to its efficacy in achieving glucose control and inability to cross the placenta. However, in recent years, oral hypoglycemic agents such as acarbose have shown promising effects on achieving glucose control and on maternal and neonatal outcomes.

Objective: To conduct a systematic analysis on randomized controlled trials (RCTs) comparing acarbose versus insulin in achieving glycemic control, as well as investigating if there are significant differences in the maternal and neonatal outcomes amongst patients with GDM.

Methods: A thorough systematic search of PubMed, Cochrane, and Google Scholar was carried out. Two reviewers independently screened abstracts and evaluated full-text articles, achieving consensus on the studies included. Both reviewers also independently performed critical appraisals of the selected studies. Meta-analysis was conducted using a random-effects model. The primary outcome assessed was achieving glycemic control, with secondary outcomes also including neonatal and maternal outcomes.

Results: Individually, none of the studies demonstrated a statistically significant difference between treatments. Pooling the results using a random-effects model yielded an overall mean difference of 2.76 mg/dL (95% CI −6.03 to 11.56), demonstrating no statistically significant difference in fasting glucose between acarbose and insulin (P = 0.31). All studies provided mean birth weight, standard deviation, and group sample sizes, allowing computation of study-level mean differences. Individual study estimates varied in both magnitude and direction. The confidence intervals of all individual studies crossed zero, indicating that none demonstrated a statistically significant difference on their own. The meta-analysis demonstrates no statistically significant difference in cesarean delivery risk between acarbose and insulin for the management of gestational diabetes. Random-effects pooling demonstrates that acarbose is not associated with an increased risk of peripartum complications compared with insulin.

Conclusion: This meta-analysis, the first to be done on comparing insulin vs acarbose, indicates that acarbose has a similar efficacy and safety profile as that of insulin therapy regarding glucose control, thus highlighting how acarbose can possibly be used as an alternative to insulin in the management of GDM. Further studies with larger sample sizes and longer follow-up are warranted.

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