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Gestational diabetes and oral hypoglycemic agents: A fresh look at the safety profile

OBG Management. 2003 August;15(08):62-76
August 1, 2003|ObGyn
Oded Langer, MD
Author and Disclosure Information

ODED LANGER, MD
Dr. Langer is Babcock Professor and chairman, department of obstetrics and gynecology, St. Luke’s-Roosevelt Hospital Center, University Hospital of Columbia University, New York, NY.

Although insulin has been the treatment of choice when dietary measures fail, oral hypoglycemic drugs are increasingly recognized as safe and effective.

Even on oral therapy, a small number of women do not attain desired levels of glucose control. For these patients, combination therapy (eg, insulin secretagogues with antihyperglycemic agents that act to improve insulin sensitivity) or insulin therapy should be substituted (TABLE 3). This approach should prevent overtreatment and unnecessary inconvenience for the patient.23-25

FIGURE Medical therapy decision path



TABLE 3

Treatment plan for gestational and type 2 diabetes

STAGE OF THERAPYINDICATIONSDECREASE IN HBA1C
Medical nutrition
  • Fasting blood glucose level <95 mg/dL (5.3 mmol/L)
  • Casual blood glucose level <120 mg/dL (6.7 mmol/L)
  • HbA1c <7%
~1%
Oral therapy: glyburide and/or metformin
  • Fasting blood glucose level >95 mg/dL (5.3 mmol/L)
  • Casual blood glucose level <140 mg/dL (7.8 mmol/L)
  • HbA1c ≥8%
~2%
Insulin
  • Fasting blood glucose level >140 mg/dL (7.8 mmol/L)
  • Casual blood glucose level >180 mg/dL (10 mmol/L)
  • HbA1c >12%
≥4%
HbA1c = glycosylated hemoglobin A1c

Dr. Langer reports no financial relationship with any companies whose products are mentioned in this article.

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