Gestational Diabetes Management and Outcomes in South Jordan: Metformin Alone vs. Metformin-Insulin Therapy, A Retrospective Cohort Study

Abstract

Background: Gestational diabetes mellitus (GDM) in Jordan displays a considerable variable prevalence, with reported rates ranging from 1.2% to 13.5%. To address this, our institution established a dedicated GDM clinic. The primary goal was to develop an efficient management system that reduces hospital admissions and improves outpatient care for pregnant women with diabetes. The current study aims to assess the cost-benefit ratio of the clinic, determine the incidence of GDM at our hospital, identify its associated risk factors, assess pregnancy outcomes, and analyze the treatment regimens applied. Methods: From March to August 2023, data from newly diagnosed women with GDM attending outpatient clinics and the GDM clinic at Al Karak Governmental Hospital were retrospectively analyzed. Extraction of information on hospital admissions, baseline maternal characteristics, and perinatal outcomes from medical records was performed. The hospital’s accounting department provided daily cost details for the patient’s stay. We then used these details to calculate the average costs over a four-day period. Descriptive analysis was performed for the maternal sociodemographics, obstetric characteristics, and perinatal outcomes. The association between categorical variables was analyzed using Fisher’s exact test. We conducted a Mantel-Haenszel (MH) analysis to evaluate the associations between selected perinatal outcomes (large for gestational age (LGA), polyhydramnios, pregnancy-induced hypertension (PIH), and neonatal intensive care unit (NICU) admission rate) and two treatment regimens (metformin vs. metformin and insulin), while controlling for the gestational age at diagnosis. SPSS version 25 was used to complete the statistical analysis. Results: During the six-month study period, 75 women were diagnosed with GDM, yielding an incidence rate of 4.97%. Hospitalization for blood sugar management decreased from 81 admissions in the previous year to 16 during the study period. A mean age of 32.6 years (±5.47) was observed among the participants, and 46% were considered obese. Two-thirds of multiparous women had a first-degree relative with diabetes, and 45% reported prior GDM. At diagnosis, 60% were less than 24 weeks pregnant. Treatment modalities included metformin alone (25.3%) and combined metformin-insulin therapy (65.3%). LGA was the most prevalent antenatal complication (30.6%). After controlling for gestational age at diagnosis, no statistically significant differences were found between treatment groups for LGA, polyhydramnios, and pregnancy-induced hypertension (MH p values: 0.505, 0.971, and 0.737, respectively). However, the combined therapy group showed a tendency towards increased odds of polyhydramnios (odd ratio (OR) 1.431, 95% confidence interval (CI) 0.285–7.173) and PIH (OR 2.818, 95% CI 0.255–31.097), but decreased odds of LGA (OR 0.476, 95% CI 0.111–2.050). Compared to the metformin-only group, the combined therapy group had significantly higher rates of NICU admissions (87% vs. 13%, p value = 0.001). 66.7% of these admissions were for hypoglycemia screening. Conclusions: This study evaluated a clinic dedicated to managing GDM in a region with a high prevalence of diabetes. The clinic improved care and created a valuable research database. Our findings revealed no significant outcome differences between insulin-treated patients and those on metformin, though the former group had higher NICU admission rates due to logistical factors. As a result of this centralized approach, we may be able to develop population-specific protocols, enhance maternal and neonatal care, and advance the management of GDM in our community and the development of new research.

Keywords

• pregnancy
• gestational diabetes
• clinic
• metformin
• metformin &amp
• insulin
• outpatient care