Publication:

Comparative fetomaternal outcomes of acarbose versus insulin in gestational diabetes mellitus: a systematic review and meta-analysis of randomized controlled trials

The prevalence of gestational diabetes mellitus (GDM) continues to increase globally, particularly in Southeast Asia. Currently, insulin remains the standard therapy for GDM, however its use is invasive and has been associated with hypoglycemia in up to 70% of patients. Acarbose is an alternative oral agent with minimal systemic absorption that works by inhibiting alpha-glucosidase enzyme. Therefore, this study aimed to evaluate the fetomaternal outcomes associated with acarbose therapy in pregnant women with GDM. A systematic search was conducted in PubMed, ScienceDirect, CENTRAL, Google Scholar, and MedRxiv following PRISMA guidelines. Outcomes were analyzed using mean difference (MD) and risk ratio (RR). A total of five studies involving 452 patients were included in the analysis. No statistically significant reduction in HbA1c levels was observed in either group. However, HbA1c tended to be lower in the acarbose group compared with the insulin group (MD=-0.11; 95% CI -0.24, 0.01; p=0.08). Similarly, no significant differences were found in birth weight (MD= -0.11; 95% CI -0.24, 0.01; p=0.08), macrosomia incidence (RR=1.31; 95% CI 0.62, 2.77; p=0.49), or neonatal hypoglycemia (RR=0.56; 95% CI 0.23, 1.36; p=0.20). Nevertheless, neonatal hypoglycemia occurred more frequently in the insulin group than in the acarbose group (20/138 vs 7/91, respectively). Acarbose may be a potential oral alternative for GDM management, demonstrating fetomaternal outcomes comparable to insulin. Nevertheless, future large-scale studies are required to confirm its efficacy and safety.