Metformin During Pregnancy: Are the Results MiTy Enough to Change Practice?

Authors
Hugh Quinn, PharmD
Mallory Telese, PharmD

Reviewers:
Erin Raney, PharmD, BCPS, BC-ADM
Rebecca Stone, PharmD, BCPS, BCACP
Morgan Moulton, PharmD, BCPS

Citation: Feig DS, Donovan LE, Zinman B, et al. Metformin in women with type 2 diabetes in pregnancy (MiTy): a multicentre, international, randomized, placebo-controlled trial. Lancet Diabetes Endocrinol. 2020;8:834-44.

The Problem

The American Diabetes Association (ADA) currently recommends insulin as the preferred agent for the management of type 2 diabetes mellitus (T2DM) during pregnancy.¹ However, metformin is routinely used as it provides several advantages over insulin including the lower cost, less maternal weight gain, and less maternal hypoglycemia. Multiple small studies have assessed the efficacy of metformin on maternal outcomes compared to insulin, however, the benefits and risks of the combination of therapies is still unclear.