Diet plus insulin compared to diet alone in the treatment of gestational diabetes mellitus: a systematic review
Autor(a) principal: | |
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Data de Publicação: | 2003 |
Outros Autores: | , , |
Tipo de documento: | Artigo |
Idioma: | eng |
Título da fonte: | Repositório Institucional da UNIFESP |
Texto Completo: | http://repositorio.unifesp.br/handle/11600/1861 http://dx.doi.org/10.1590/S0100-879X2003001000004 |
Resumo: | Fetuses of mothers with gestational diabetes mellitus are at increased risk to develop perinatal complications mainly due to macrosomia. However, in view of the marked heterogeneity of this disease, it seems difficult to set guidelines for diagnosis and treatment. This complicates the choice of assigning patients either to diet or to insulin therapy. Also of concern is how much benefit could be expected from insulin therapy in preventing fetal complications in these patients. In a systematic review of the literature assessing the efficacy of insulin in preventing macrosomia in fetuses of mothers with gestational diabetes, we found six randomized controlled trials comparing diet alone to diet plus insulin. The studies included a total of 1281 patients (644 in the diet plus insulin group and 637 in the diet group), with marked differences among trials concerning diagnostic criteria, randomization process and treatment goals. Meta-analysis of the data resulted in a risk difference of -0.098 (95%CI: -0.168 to -0.028), and a number-necessary-to-treat of 11 (95%CI: 6 to 36), which means that it is necessary to treat 11 patients with insulin to prevent one case of macrosomia. This indicates a potential benefit of insulin, but not significantly enough to set treatment guidelines. Because of the heterogeneous evidence available in the literature about this matter, we conclude that larger trials addressing the efficacy of these two therapeutic modalities in preventing macrosomia are warranted. |
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Giuffrida, Fernando de Mello Almada [UNIFESP]Castro, Aldemar Araujo [UNIFESP]Atallah, Álvaro Nagib [UNIFESP]Dib, Sergio Atala [UNIFESP]Universidade Federal de São Paulo (UNIFESP)2015-06-14T13:30:08Z2015-06-14T13:30:08Z2003-10-01Brazilian Journal of Medical and Biological Research. Associação Brasileira de Divulgação Científica, v. 36, n. 10, p. 1297-1300, 2003.0100-879Xhttp://repositorio.unifesp.br/handle/11600/1861http://dx.doi.org/10.1590/S0100-879X2003001000004S0100-879X2003001000004.pdfS0100-879X200300100000410.1590/S0100-879X2003001000004WOS:000185906900005Fetuses of mothers with gestational diabetes mellitus are at increased risk to develop perinatal complications mainly due to macrosomia. However, in view of the marked heterogeneity of this disease, it seems difficult to set guidelines for diagnosis and treatment. This complicates the choice of assigning patients either to diet or to insulin therapy. Also of concern is how much benefit could be expected from insulin therapy in preventing fetal complications in these patients. In a systematic review of the literature assessing the efficacy of insulin in preventing macrosomia in fetuses of mothers with gestational diabetes, we found six randomized controlled trials comparing diet alone to diet plus insulin. The studies included a total of 1281 patients (644 in the diet plus insulin group and 637 in the diet group), with marked differences among trials concerning diagnostic criteria, randomization process and treatment goals. Meta-analysis of the data resulted in a risk difference of -0.098 (95%CI: -0.168 to -0.028), and a number-necessary-to-treat of 11 (95%CI: 6 to 36), which means that it is necessary to treat 11 patients with insulin to prevent one case of macrosomia. This indicates a potential benefit of insulin, but not significantly enough to set treatment guidelines. Because of the heterogeneous evidence available in the literature about this matter, we conclude that larger trials addressing the efficacy of these two therapeutic modalities in preventing macrosomia are warranted.Universidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Departamento de MedicinaUNIFESP, EPM, Depto. de MedicinaSciELO1297-1300engAssociação Brasileira de Divulgação CientíficaBrazilian Journal of Medical and Biological ResearchDiabetesGestationalDiet therapyFetal macrosomiaInsulinMeta-analysisDiet plus insulin compared to diet alone in the treatment of gestational diabetes mellitus: a systematic reviewinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articleinfo:eu-repo/semantics/openAccessreponame:Repositório Institucional da UNIFESPinstname:Universidade Federal de São Paulo (UNIFESP)instacron:UNIFESPORIGINALS0100-879X2003001000004.pdfapplication/pdf474821${dspace.ui.url}/bitstream/11600/1861/1/S0100-879X2003001000004.pdfc826b58fa2351ed84686735bea2ccd9cMD51open accessTEXTS0100-879X2003001000004.pdf.txtS0100-879X2003001000004.pdf.txtExtracted texttext/plain11956${dspace.ui.url}/bitstream/11600/1861/2/S0100-879X2003001000004.pdf.txt0d8d6d588e55580c1b92b06fe3254a61MD52open access11600/18612021-10-05 21:50:00.77open accessoai:repositorio.unifesp.br:11600/1861Repositório InstitucionalPUBhttp://www.repositorio.unifesp.br/oai/requestopendoar:34652021-10-06T00:50Repositório Institucional da UNIFESP - Universidade Federal de São Paulo (UNIFESP)false |
dc.title.en.fl_str_mv |
Diet plus insulin compared to diet alone in the treatment of gestational diabetes mellitus: a systematic review |
title |
Diet plus insulin compared to diet alone in the treatment of gestational diabetes mellitus: a systematic review |
spellingShingle |
Diet plus insulin compared to diet alone in the treatment of gestational diabetes mellitus: a systematic review Giuffrida, Fernando de Mello Almada [UNIFESP] Diabetes Gestational Diet therapy Fetal macrosomia Insulin Meta-analysis |
title_short |
Diet plus insulin compared to diet alone in the treatment of gestational diabetes mellitus: a systematic review |
title_full |
Diet plus insulin compared to diet alone in the treatment of gestational diabetes mellitus: a systematic review |
title_fullStr |
Diet plus insulin compared to diet alone in the treatment of gestational diabetes mellitus: a systematic review |
title_full_unstemmed |
Diet plus insulin compared to diet alone in the treatment of gestational diabetes mellitus: a systematic review |
title_sort |
Diet plus insulin compared to diet alone in the treatment of gestational diabetes mellitus: a systematic review |
author |
Giuffrida, Fernando de Mello Almada [UNIFESP] |
author_facet |
Giuffrida, Fernando de Mello Almada [UNIFESP] Castro, Aldemar Araujo [UNIFESP] Atallah, Álvaro Nagib [UNIFESP] Dib, Sergio Atala [UNIFESP] |
author_role |
author |
author2 |
Castro, Aldemar Araujo [UNIFESP] Atallah, Álvaro Nagib [UNIFESP] Dib, Sergio Atala [UNIFESP] |
author2_role |
author author author |
dc.contributor.institution.none.fl_str_mv |
Universidade Federal de São Paulo (UNIFESP) |
dc.contributor.author.fl_str_mv |
Giuffrida, Fernando de Mello Almada [UNIFESP] Castro, Aldemar Araujo [UNIFESP] Atallah, Álvaro Nagib [UNIFESP] Dib, Sergio Atala [UNIFESP] |
dc.subject.eng.fl_str_mv |
Diabetes Gestational Diet therapy Fetal macrosomia Insulin Meta-analysis |
topic |
Diabetes Gestational Diet therapy Fetal macrosomia Insulin Meta-analysis |
description |
Fetuses of mothers with gestational diabetes mellitus are at increased risk to develop perinatal complications mainly due to macrosomia. However, in view of the marked heterogeneity of this disease, it seems difficult to set guidelines for diagnosis and treatment. This complicates the choice of assigning patients either to diet or to insulin therapy. Also of concern is how much benefit could be expected from insulin therapy in preventing fetal complications in these patients. In a systematic review of the literature assessing the efficacy of insulin in preventing macrosomia in fetuses of mothers with gestational diabetes, we found six randomized controlled trials comparing diet alone to diet plus insulin. The studies included a total of 1281 patients (644 in the diet plus insulin group and 637 in the diet group), with marked differences among trials concerning diagnostic criteria, randomization process and treatment goals. Meta-analysis of the data resulted in a risk difference of -0.098 (95%CI: -0.168 to -0.028), and a number-necessary-to-treat of 11 (95%CI: 6 to 36), which means that it is necessary to treat 11 patients with insulin to prevent one case of macrosomia. This indicates a potential benefit of insulin, but not significantly enough to set treatment guidelines. Because of the heterogeneous evidence available in the literature about this matter, we conclude that larger trials addressing the efficacy of these two therapeutic modalities in preventing macrosomia are warranted. |
publishDate |
2003 |
dc.date.issued.fl_str_mv |
2003-10-01 |
dc.date.accessioned.fl_str_mv |
2015-06-14T13:30:08Z |
dc.date.available.fl_str_mv |
2015-06-14T13:30:08Z |
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info:eu-repo/semantics/publishedVersion |
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info:eu-repo/semantics/article |
format |
article |
status_str |
publishedVersion |
dc.identifier.citation.fl_str_mv |
Brazilian Journal of Medical and Biological Research. Associação Brasileira de Divulgação Científica, v. 36, n. 10, p. 1297-1300, 2003. |
dc.identifier.uri.fl_str_mv |
http://repositorio.unifesp.br/handle/11600/1861 http://dx.doi.org/10.1590/S0100-879X2003001000004 |
dc.identifier.issn.none.fl_str_mv |
0100-879X |
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S0100-879X2003001000004.pdf |
dc.identifier.scielo.none.fl_str_mv |
S0100-879X2003001000004 |
dc.identifier.doi.none.fl_str_mv |
10.1590/S0100-879X2003001000004 |
dc.identifier.wos.none.fl_str_mv |
WOS:000185906900005 |
identifier_str_mv |
Brazilian Journal of Medical and Biological Research. Associação Brasileira de Divulgação Científica, v. 36, n. 10, p. 1297-1300, 2003. 0100-879X S0100-879X2003001000004.pdf S0100-879X2003001000004 10.1590/S0100-879X2003001000004 WOS:000185906900005 |
url |
http://repositorio.unifesp.br/handle/11600/1861 http://dx.doi.org/10.1590/S0100-879X2003001000004 |
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eng |
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eng |
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Brazilian Journal of Medical and Biological Research |
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1297-1300 |
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Associação Brasileira de Divulgação Científica |
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Associação Brasileira de Divulgação Científica |
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