A review of current treatment strategies for gestational diabetes mellitus

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Approximately 90% of diabetes cases in pregnant women are considered gestational diabetes mellitus (GDM). It is well known that uncontrolled glucose results in poor pregnancy outcomes in both the mother and fetus. Worldwide there are many guidelines with recommendations for appropriate management strategies for GDM once lifestyle modifications have been instituted and failed to achieve control. The efficacy and particularly the safety of other treatment modalities for GDM has been the source of much debate in recent years. Studies that have demonstrated the safety and efficacy of both glyburide and metformin in the management of patients with GDM will be reviewed. There is a lack of evidence with other oral and injectable non-insulin agents to control blood glucose in GDM. The role of insulin will be discussed, with emphasis on insulin analogs. Ideal patient characteristics for each treatment modality will be reviewed. In addition, recommendations for postpartum screening of patients will be described as well as recommendations for use of agents to manage subsequent type 2 diabetes in patients who are breastfeeding.

Keywords: gestational diabetes, fetal macrosomia, glyburide, hypoglycemia, hypoglycemic agents, insulin, long-acting insulin, short-acting insulin, metformin, postnatal care.

Abbreviations: GCT, glucose challenge test; GDM, gestational diabetes mellitus; LGA, large for gestational age; NICU, neonatal intensive care unit; OGTT, oral glucose tolerance test; T2DM, type 2 diabetes mellitus.

Citation: Kelley KW, Carroll DG, Meyer A. A review of current treatment strategies for gestational diabetes mellitus. Drugs in Context 2015; 4: 212282. DOI: 10.7573/dic.212282

Contributions: KWK, DCG, and AM had full access to all of the data in the review and take responsibility for the integrity of the data and the accuracy of the data analysis. Interpretation of the data: KWK, DCG, AM; drafting of the manuscript: KWK, DCG, AM; critical revision of the manuscript for content: KWK, DCG, AM; administrative, technical or material support: KWK, DCG, AM.

Potential conflicts of interest: The International Committee of Medical Journal Editors’ (ICMJE) Potential Conflicts of Interests forms for the authors are available for download at: https://www.drugsincontext.com/wp-content/uploads/2015/07/dic.212282-COI.pdf. The authors declare no conflicts of interest.

Funding declaration: None to declare.

Copyright: Copyright © 2015 Kelley KW, Carroll DG, Meyer A. Distributed under the terms of the Creative Commons License Deed CC BY NC ND 3.0 which allows anyone to copy, distribute, and transmit the article provided it is properly attributed in the manner specified below. No commercial use without permission.

Correction attribution: Copyright © 2015 Kelley KW, Carroll DG, Meyer A. http://dx.doi.org/10.7573/dic.212282. Published by Drugs in Context under Creative Commons License Deed CC BY NC ND 3.0.

Article URL: https://www.drugsincontext.com/a-review-of-current-treatment-strategies-for-gestational-diabetes-mellitus

Correspondence: Kristi W Kelley, PharmD, BCPS, CDE, BC-ADM; Continuity of Care Clinic, Trinity Medical Center, 840 Montclair Road, Suite 122, Birmingham, Alabama 35213, USA. watsokm@auburn.edu

Provenance: Invited; externally peer reviewed

Submitted: 2 May 2015; Peer review comments to author: 19 May 2015; Published: 15 July 2015

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