Skenario :

Seorang Wanita usia 32 tahun G2P1A0 , saat ini wanita tersebut sedang hamil anak ke 2 dengan usia kandungan 32 minggu, datang dengan keluhan akhir- akhir ini sering buang air kecil, keluhan disertai juga dengan sering merasa haus dan lapar, sebelumnya tidak pernah dirasakan oleh wanita tersebut. Wanita tersebut khawatir terjadi sesuatu pada kehamilannya kemudian memeriksakan diri ke dokter didapatkan hasil GDS 160 GDP 120, dokter mendiagnosis wanita tersebut mengalami Diabetes Mellitus Gestasional kemudian dokter akan memberikan terapi untuk ibu tersebut. dokter harus memilih terapi yang lebih efektif dengan tidak mengesampingkan Evidence Based Medecine untuk memilih terapi insulin atau metformin.

1. Pertanyaan (foreground question):

Bagaimanakah prognosis yang akan didapatkan oleh pasien dengan mengkonsumsi metformin atau insulin?

2.PICO:

Patient/Population : ibu hamil dengan DM

Indicator : Prognosis dengan metformin

Comparative : Prognosis dengan insulin

Outcome :ibu yang mengonsumi metformin prognosis kelahiran bayinya lebih baik

3. Keyword :

Metformin AND Insulin AND Gestational Diabetes

4. Source : http://www.ncbi.nlm.nih.gov/pubmed

5. Hasil pencarian: 99

6.Limitation : 2013

7. artikel

Juan Gui, Qing Liu, Ling Feng*

Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China

AbstractBackground: Nowadays, there have been increasing studies comparing metformin with insulin. But the use of metformin in pregnant women is still controversial, therefore, we aim to examine the efficiency and safety of metformin by conducting a meta-analysis of randomized controlled trials (RCTs) comparing the effects of metformin with insulin on glycemic control, maternal and neonatal outcomes in gestational diabetes mellitus (GDM).

Methods: We used the key words ‘‘gestational diabetes’’ in combination with ‘‘metformin’’ and searched the databases including Pubmed, the Cochrane Library, Web of knowledge, and Clinical Trial Registries. A random-effects model was used to compute the summary risk estimates.

Results: Meta-analysis of 5 RCTs involving 1270 participants detected that average weight gains after enrollment were much lower in the metformin group (n = 1006, P = 0.003, SMD =20.47, 95%CI [20.77 to 20.16]); average gestational ages at delivery were significantly lower in the metformin group (n = 1270, P = 0.02, SMD =20.14, 95%CI [20.25 to 20.03]); incidence of preterm birth was significantly more in metformin group (n = 1110, P = 0.01, OR = 1.74, 95%CI [1.13 to 2.68]); the incidence of pregnancy induced hypertension was significantly less in the metformin group (n = 1110, P = 0.02, OR = 0.52, 95%CI [0.30 to 0.90]). The fasting blood sugar levels of OGTT were significantly lower in the metformin only group than in the supplemental insulin group (n = 478, P = 0.0006, SMD =20.83, 95%CI [21.31 to 20.36]).

Conclusions: Metformin is comparable with insulin in glycemic control and neonatal outcomes. It might be more suitablefor women with mild GDM. This meta-analysis also provides some significant benefits and risks of the use of metformin in GDM and help to inform further development of management guidelines.

Citation: Gui J, Liu Q, Feng L (2013) Metformin vs Insulin in the Management of Gestational Diabetes: A Meta-Analysis. PLoS ONE 8(5): e64585. doi:10.1371/journal.pone.0064585Editor: Raffaella Buzzetti, Sapienza, University, ItalyReceived December 28, 2012; Accepted April 16, 2013; Published May 27, 2013Copyright: _ 2013 Gui et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.Funding: The authors have no support or funding to report.Competing Interests: The authors have declared that no competing interests exist.

I. APAKAH HASILNYA VALID?1. Apakah ada sampel pasien yang representative dan didefinisikan secara jelas pada titik

yang sama / similar point dalam perjalan penyakit / course of the disease?

2. Apakah follow-up lengkap dan cukup lama / sufficiently long and complete?