Help Guide Management of Gestational Diabetes

Gestational diabetes rates have risen sharply in the past few years...likely driven by obesity, which was worsened by the pandemic.

We know these patients are at increased risk of C-section, high birth weight, future diabetes, preeclampsia, etc.

Guide safe use if meds for gestational diabetes are started or continued during a hospitalization.

Generally use insulin first-line. It has the longest track record...and is easier to fine-tune as pregnancy progresses. Plus oral meds aren’t always enough in these patients.

If insulin isn’t an option for outpatient use, consider metformin. It causes less weight gain than insulin, but has less overall safety data.

Save glyburide as a last resort. It’s linked to worse outcomes (high birth weight, etc) than metformin or insulin.

Avoid other sulfonylureas AND other diabetes meds (GLP-1 agonists, SGLT2 inhibitors, etc)...due to lack of long-term data.

At discharge, counsel patients about monitoring and follow-up.

Advise checking blood glucose 4 times a day...using a standard blood glucose meter. Evidence with continuous glucose monitors is limited in gestational diabetes.

Educate to aim for a fasting glucose of less than 95 mg/dL...and less than 140 mg/dL 1 hour after meals OR less than 120 mg/dL 2 hours after meals.

Explain that after delivery, gestational diabetes meds are usually stopped. But emphasize postpartum follow-up to identify and manage possible prediabetes, type 2 diabetes, CV risks, etc.

Key References

  • Natl Vital Stat Rep. 2022 Jul;71(3):1-15
  • Diabetes Care. 2022 Jan 1;45(Suppl 1):S232-S243
  • Obstet Gynecol. 2018 Feb;131(2):e49-e64
  • JAMA. 2021 Aug 10;326(6):531-538
  • Am J Obstet Gynecol. 2018 May;218(5):B2-B4
Hospital Pharmacist's Letter. September 2022, No. 380907

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