Initiate non-insulin therapy
Compared with insulin, oral Glu lowering agents are less expensive, do not require educational instruction at initiation of therapy and are preferred by most patients.
According to ES Guidelines, availiable choices are glyburide and metformin. The criteria for each choice are stated bellow:
R5.2a Suggest glyburide is a suitable alternative to insulin therapy for women who fail to achive sufficient glycemic control after 1 week trial of medical nutrition therapy and exercise unless:
- Gestational age < 25w or
- Fasting plasma Glu > 110 mg/dL (2++)
Glyburide appears safe an effective alternative to insulin in most women with GDM though its lack of food and drug administration (FDA) appoval.
R 5.2b Suggest metformin therapy be used for glycemic control only for women who fail to achive sufficient glycemic control after 1 week trial of medical nutrition therapy and exercise and:
- Refuse or cannot use insulin and
- Refuse or cannot use glyburide and
- are not in 1st trimester (2++)
Is glycemic control sufficient?
Map: Management of overt diabetes (DM) and gestational diabetes (GDM) (305)
Node: 7742
Score:
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