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Managing gestational diabetes: timing, selection and use of pharmacotherapy

Stephen F Thung & Mark B Landon

Recent data demonstrate that identifying and managing gestational diabetes is an important part of prenatal care to maximize perinatal outcomes. The variety of therapies available to maintain euglycemia continues to expand and it is important for obstetrical care providers to keep abreast of new therapeutic opportunities. Although injectable insulin has been available for decades, advances in insulin design have truly revolutionized how it is administered and, ultimately, improved glucose management. Beyond insulin, oral hypoglycemic agents such as glyburide and metformin continue to gain popularity due to patients’ requests and ease of use. In this review, we present the available data to help providers understand what therapies are available, their unique strengths and weaknesses, and how to initiate and escalate doses to achieve maternal euglycemia.