ABSTRACT
The mainstay of gestational diabetes mellitus (GDM) management is dietary therapy, exercise, and self-monitoring of blood glucose. Most clinicians use this time frame to determine dietary failure and to initiate pharmacologic therapy. There is no conclusive evidence for the threshold number of blood glucoses above target or the absolute blood glucose value at which a clinician should initiate pharmacologic therapy. Once the decision to initiate medication treatment is made, the clinician must decide which pharmacologic agent to use. For years, gold standard for treating women with GDM who fail to achieve euglycemia on dietary management alone has been insulin injections. Advantages of oral hypoglycemic agents include less patient discomfort, fewer supplies, and less office infrastructure needed that may lead to increased patient satisfaction and compliance with pharmacologic therapy. The other hypoglycemic agent studied for the treatment of GDM is metformin, a biguanide. It inhibits hepatic gluconeogenesis, increases intestinal glucose absorption, and stimulates glucose uptake in the liver and peripheral tissues.
