Medications Used To Treat Gestational Diabetes (GDM)

Gestational Diabetes is the most common cause of pregnancy-related complications. Its proper treatment and management are crucial to avoid adverse effects.

Gestational diabetes refers to the incidence of diabetes mellitus during pregnancy. Controlling gestational diabetes with lifestyle intervention is essential and the usual first step, however, medications are needed to achieve the targets in most pregnant women.

Insulin is considered the first line of treatment. Among medications used to treat gestational diabetes, metformin is considered the safest.

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Metformin for Gestational Diabetes:

While some women may manage their blood sugar levels only through food and exercise, others will also need to take pills or receive injections.

For many years, people have used the medication metformin to reduce their blood sugar levels. It improves how well insulin functions in your body. It delays the absorption of food-derived sugar into the blood.

Exercise frequently and maintain a balanced diet to get the most benefit from metformin.

You should take a tablet with food two or three times every day.

You and your unborn child may be impacted by untreated gestational diabetes. As your blood glucose levels rise, the hazards to both you and your unborn child rise.

Metformin helps reduce these risks:

For the mother, metformin helps in lowering the chances of cesarean delivery, high levels of blood pressure, and incidence of diabetes after pregnancy.
It also protects the baby from jaundice, growing larger in size than normal, premature births, and breathing issues.

Is it safe to use?

It has been proven through clinical research that metformin is safe to use in treating gestational diabetes.

Your blood pressure and weight loss are both controlled with metformin.

The most common adverse effect is stomach distress, including nausea and diarrhea. Metformin should be taken with food to prevent stomach issues. Throughout your pregnancy, you will need to monitor your blood glucose levels.

Is it safe for the baby?

Your baby won’t be harmed if you take metformin for gestational diabetes. All of the above-mentioned hazards for your unborn child are decreased by lowering your blood glucose.

Your kid is also more likely to have a healthy weight than with insulin treatment, less likely to experience low blood sugar, and less likely to require hospitalization.

The infant’s development is unaffected by metformin.

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Glyburide for Gestational Diabetes:

Similar to metformin, glyburide is also recommended by many institutes for the treatment of diabetes during pregnancy. It is considered for women who do not achieve their target blood glucose with lifestyle intervention and metformin.

However, most pregnant women who opt to use glyburide are usually those who want to avoid insulin.

According to American Diabetes Association, major specialty bodies continue to urge caution in adopting oral agents (such as glyburide) as an acceptable modality for managing gestational diabetes mellitus (GDM) despite the fact that a randomized controlled trial showing clinical equivalence of glyburide and insulin for GDM management was published more than 4 years ago.

Another study showed that the effectiveness of glyburide in managing blood sugar levels was equal to that of insulin. [ref]

Dose of Glyburide in GDM:

However, there was one study that evaluated that while a higher starting dosage of glyburide was not linked to better newborn outcomes, it was also not linked to improved maternal hypoglycemia in a subset of patients.

This may be because of the maternal traits linked to a higher starting dose regimen. The study results in this group with patients starting higher glyburide regimens tended to have higher fasting glucose readings, greater chronic hypertension, and higher BMI.

These results show that initial dosages of 2.5–5 mg/day are comparably acceptable substitutes for clinical usage until further dosage information on the use of glyburide during pregnancy is available. [ref]

It is important to note that Glyburide and Glibenclamide are the same drugs. Americans call it Glyburide while Europeans call it Glibenclamide.

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Insulin

Currently, the best and most effective treatment in the therapy of gestational diabetes is insulin.

For the vast majority of pregnant women with gestational diabetes mellitus, insulin remains the treatment of choice (GDM). [ref]

For people with type 1 diabetes, type 2 diabetes, and uncontrolled GDM during pregnancy, insulin therapy continues to be the gold standard of care.

Most pregnant women have reported using regular insulin, insulin Aspart, insulin Lispro, Glulisine, and NPH.

Insulin detemir offers an extra option for basal coverage and is rapidly accumulating data. Patients may be using insulin that lacks human data for pregnant patients before becoming pregnant as we enter a new era of insulin technology.

Clinicians’ ability to accurately weigh the advantages and disadvantages of modifying insulin therapy will be essential. Additionally, it is crucial to discuss the findings with the patient so that she can participate in choosing the appropriate insulin regimen.

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Summary:

Feature	Metformin	Glyburide	Insulin
Function	Improves insulin sensitivity.	Enhances insulin secretion	Regulates blood glucose levels
Dosage	Twice daily	2.5-5 mg/ day	Doses vary depending on blood glucose. The usual starting dose is 10-20 units. The usual maintenance dose is 0.7-2 units per kg of pregnancy weight.
Efficacy in GDM	Very effective	It is effective as insulin but it should be used with caution	The best and most effective treatment for GDM
Benefits	Lowers the chance of C-sections, premature births, and jaundice in infants.	Normal birth weight infants	Prevents maternal and fetal complications
Side Effects	Stomach Distress, Nausea, Diarrhea	High doses are associated with hypoglycemia, hypertension, and high BMI	Hypoglycemia