For Gestational Diabetes Pharmacotherapy, Insulin Reigns Supreme
In this issue of JAMA, Rademaker and colleagues report the results of a randomized noninferiority trial comparing 2 pharmacotherapy approaches for gestational diabetes: a sequential oral medication strategy vs an insulin-first strategy. Recent data suggest that more than 8% of pregnant individuals in the United States are diagnosed with gestational diabetes; of these, more than 40% may need medication to achieve recommended intensive pregnancy glycemic targets. These estimates imply that more than 100 000 pregnant people in the US will require pharmacotherapy for gestational diabetes yearly. It is well established that treatment of even “mild” gestational diabetes with lifestyle measures, self blood glucose monitoring, and (if needed) medication reduces the risk of fetal overgrowth, a canonical complication of hyperglycemia in pregnancy linked to perinatal morbidity, including birth injury and neonatal hypoglycemia.
In this issue of JAMA, Rademaker and colleagues report the results of a randomized noninferiority trial comparing 2 pharmacotherapy approaches for gestational diabetes: a sequential oral medication strategy vs an insulin-first strategy. Recent data suggest that more than 8% of pregnant individuals in the United States are diagnosed with gestational diabetes; of these, more than 40% may need medication to achieve recommended intensive pregnancy glycemic targets. These estimates imply that more than 100 000 pregnant people in the US will require pharmacotherapy for gestational diabetes yearly. It is well established that treatment of even “mild” gestational diabetes with lifestyle measures, self blood glucose monitoring, and (if needed) medication reduces the risk of fetal overgrowth, a canonical complication of hyperglycemia in pregnancy linked to perinatal morbidity, including birth injury and neonatal hypoglycemia.
