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NCT Number: NCT03875755

Myo-inositol for Reduction of Insulin Therapy in Gestational Diabetes Mellitus

Gestational diabetes mellitus (GDM) is defined as hyperglycemia first-diagnosed during pregnancy. Glycemic control reduces GDM-related complications. With the new diagnostic criteria of GDM, up to 25% of pregnant women have GDM, whereas it was previously 6-10% in France. Therefore caring for women with GDM is very time-consuming. Therapeutic strategy includes dietary and lifestyle measures and additional insulin therapy for 15 to 40% of the women with GDM if the glycemic targets are not achieved after a period of 1 to 2 weeks of diet. Insulin therapy is imperfect for the following main reasons: need for education (i.e. subcutaneous administration, dose titration), hypoglycemia and weight gain, limited acceptance and high cost. Psychosocial deprivation is associated with more cases of GDM and health accessibility may be unequal.

MYO-INOSITOL (MI) is an oral dietary supplement, which reduces insulin resistance. Women with GDM are deficient in MI. MI supplementation safely prevents GDM by 65 to 87% in high-risk women. A pilot study has shown a 75% reduction of the need for insulin during GDM not controlled by diet.

The coordinator investigator propose here, for the first time, a randomized controlled study evaluating MI versus placebo in women with newly diagnosed GDM.

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This study is active but is not currently recruiting participants.

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Key information

Conditions

Gestational Diabetes Mellitus Diabetes Mellitus Diabetes, Gestational Endocrine System Diseases Female Urogenital Diseases and Pregnancy Complications Glucose Metabolism Disorders Metabolic Diseases Nutritional and Metabolic Diseases Pregnancy Complications Urogenital Diseases

Age range

18 year–45 year

Sex eligibility

All sexes

Study type

Interventional

Phase

Not applicable

Primary location

Hopital Avicenne, Bobigny, France

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About this study

Prospective, multicenter, superiority, randomised, double blind study with two arms.

  • In the 23 participating centers selection of women with GDM between 6 to 37 (+6 days) amenorrhea weeks
  • Explanation of protocol, with signature of consent in case of acceptation.
  • Randomization
  • Experimental group: The women will receive 2 caps of MI with acid folic a day, until delivery
  • Control group: The women will receive 2 caps of placebo (containing only acid folic) a day, until delivery

In both arms, the participants will be routinely followed up during pregnancy:

  • diet education,
  • self-monitoring of blood glucose before and after meals
  • and during follow-up insulin therapy if glucose value targets are unmet
  • Routine monitoring of the women with GDM in both arms, up to delivery, without use of other oral hypoglycemic agents during pregnancy.

At delivery:

  • MI (or placebo) will be stopped
  • Events during pregnancy will be collected
  • Last visit three months after delivery. Oral glucose tolerance test, anthropometric measures for women and their child.

Who can participate

Healthy volunteers accepted: No

Only the study team can determine whether someone qualifies for participation.

Inclusion criteria

  • Age ≥18 years
  • Singleton pregnancy
  • GDM diagnosed during pregnancy according to IADPSG (International Association of the Diabetes and Pregnancy Study Groups) criteria, i.e.
  • fasting plasma glucose between 92 mg/dL (5.1 mmol/L) and 125 mg/dL (6.9 mmol/L)
  • and/or 1-hour plasma glucose value after 75 g oral glucose tolerance test (OGTT) ≥ 180 mg/dL (10.0 mmol/L)
  • and/or 2-hour plasma glucose value between 153 mg/dL (8.5 mmol/L) and 199 mg/dL ((11.0 mmol/L)
  • or overt diabetes according to 2-hours post OGTT plasma glucose value ≥ 200 mg/dl
  • 6 to 37 (+6 days) amenorrhea weeks at the time of randomization
  • Capacity for self-monitoring of blood glucose
  • Signed informed consent

Exclusion criteria

  • Insulin use before randomization during this pregnancy
  • Use of other oral hypoglycemic agents during this pregnancy
  • Long time corticosteroid treatment
  • Pre-existing diabetes before pregnancy
  • Overt diabetes diagnosed during pregnancy according to fasting plasma glucose ≥ 126 mg/dL (7 mmol/l)
  • Lack of Social Insurance
  • Insufficient French understanding and speaking
  • Participant in another investigational drug study at inclusion visit
  • Fetal malformation diagnosed by previous fetal ultrasound
  • Personal history of any bariatric surgery
  • Hypersensitivity to any ingredient of dietary supplement formulation

Treatment and study plan

Myo Inositol

Dietary Supplement

One soft gel capsule containing MI 600 mg and folic acid 200 μg twice a day, until delivery.

Other names: INOFOLIC

Placebo

Other

One soft gel capsule of placebo (folic acid 200 μg) twice a day until delivery.

Primary outcomes

  1. Rate of patients requiring insulin therapy during pregnancy

    Time frame: At any time during pregnancy up to delivery; assessed up to 29 weeks.

    Rate of patients requiring insulin therapy (either basal or prandial). .

Secondary outcomes

  1. - Rate of patients requiring basal insulin therapy during pregnancy- /Rate of patients requiring prandial insulin therapy during pregnancy

    Time frame: At any time during pregnancy up to delivery; assessed up to 29 weeks.

    This information will be retrieved from the glucose meter, and if not available, from the woman's diary

  2. - Doses of basal and prandial insulin at delivery- Gestation age when insulin is began - Duration of insulin treatment

    Time frame: At delivery; assessed up to 29 weeks.

    • Dose of basal insulin (UI) at delivery, if any
    • Dose of prandial insulin (UI) at delivery, if any
    • Gestational age (SA) when basal insulin is started.
    • Gestational age (SA) when prandial insulin is started
    • Duration of basal insulin treatment at delivery, if any
    • Duration of prandial insulin treatment at delivery, if any

  3. Gestational weight gain

    Time frame: At any time during pregnancy up to delivery; assessed up to 29 weeks.

    • Gestational weight gain (Kg) during pregnancy
    • Gestational weight gain (Kg) between inclusion and delivery

  4. Hypoglycemia

    Time frame: from randomization to delivery; assessed up to 29 weeks.

    • Severe hypoglycemia: requiring assistance of another person to actively administer carbohydrates, glucagon, or take other corrective actions. Plasma Glucose concentrations may not be available during an event, but neurological recovery following the return of plasma/capillary glucose to normal is considered sufficient evidence that the event was induced by a low plasma/capillary glucose concentration.
    • Documented symptomatic hypoglycemia: event during which typical symptoms of hypoglycemia are accompanied by a measured capillary glucose concentration <70 mg/dL (<3.9 mmol/L).
    • Asymptomatic hypoglycemia: event not accompanied by typical symptoms of hypoglycemia but with a measured capillary glucose concentration <60 mg/dL (<3.3 mmol/L).

  5. Capillary glucose levels

    Time frame: From the beginning of MI Supplementation to delivery;assessed up to 29 weeks.

    The women will be asked to perform 6 measures a day. Capillary glucose values will be retrieved from the glucose meter, and if not available, from the woman's diary.

  6. Neonatal complications

    Time frame: At delivery; assessed up to 29 weeks

    • Birth weight ≥ 4000g; ≥ 4500g ; large and small for gestational age infant
    • Neonatal hypoglycemia defined as at least a blood glucose value lower than 2.0 mmol/l after 2 hours of life during the two first days of life if the newborn is asymptomatic
    • Shoulder dystocia, defined as vaginal cephalic delivery
    • Birth injury defined as plexus injury or clavicle fracture
    • Preterm delivery:
    • Late preterm infant (between 32 and 37 completed amenorrhea weeks)
    • Very preterm infant (28-31 completed amenorrhea weeks)
    • Extreme preterm infant (less than 28 completed amenorrhea weeks)
    • Low Apgar score: 5-min Apgar score < 7• Jaundice, defined as need for neonatal phototherapy • Neonatal respiratory distress syndrome, based on the clinical course, chest X-ray finding, blood gas and acid-base values • Medical need for admission to pediatric or neonatal intensive care unit during the three days following birth • Malformations: the types of malformation will be recorded.

  7. Preeclampsia - Pregnancy-induced hypertension - Cesarean section - Maternal inpatient admission during pregnancy

    Time frame: At any time during pregnancy up to delivery; assessed up to 29 weeks.

    • Preeclampsia (blood pressure ≥ 140/90 mmHg on two measurements four hours apart and proteinuria of at least 300 mg/24 hours or 3+ or more on dipstick testing or proteinuria/creatinuria >30 in a random urine sample)
    • Pregnancy-induced hypertension: in women with no known hypertension before pregnancy, blood pressure ≥ 140/90 mmHg on two measurements four hours apart without proteinuria and having needed to begin anti-hypertensive therapy
    • Maternal inpatient admission during pregnancy after inclusion, not including hospitalization just after delivery

  8. Side effects

    Time frame: From the beginning of MI Supplementation to delivery; assessed up to 29 weeks.

    The investigators expect MI not to have any side effect at the dose 1200 mg/day, but possible side effects will be collected.

  9. Results of oral glucose tolerance test

    Time frame: 3 months after delivery

    Test will be performed by the women 3 months post partum

  10. Infant anthropometrics.

    Time frame: At month 1, month 2 and month 3

    These data will be collected from children's health record

  11. Acceptance/satisfaction of 2 strategies: score

    Time frame: At delivery; assessed up to 29 weeks.

    Evaluation of the patient's satisfaction about their treatment for GDM at delivery : give a score of 0 to 100: 0 not satisfied; 100 totally satisfied

Sponsors and collaborators

Lead sponsor

Assistance Publique - Hôpitaux de Paris

Other

Registry information

Official study title

Reduction of Insulin Therapy Under Myo-inositol for the Treatment of Gestational Diabetes Mellitus: a Randomized Multicenter and Prospective Trial. MYO-GDM Study

Acronym: MYO-GDM

Important dates

Study start
2020
Primary completion
2026
Study completion
2027
First posted
Mar 15, 2019
Registry last updated
Dec 29, 2025

OpenTrials presents study information sourced from ClinicalTrials.gov. The official registry record should be consulted for the latest information.

View the official ClinicalTrials.gov record (opens in a new tab)

This listing is for discovery and informational purposes only. It is not medical advice, does not guarantee that a study is recruiting, and does not determine eligibility. Contact the study team and a qualified healthcare professional when considering participation.

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