Gestational Diabetes Treatment

[EGVnurse]

I'm receiving conflicting information on the standard, safest medication treatment for a woman diagnosed with gestational diabetes (GDM) whose blood glucose is not being controlled with carbohydrate-counting/meal planning and physical activity.

I have seen women on glyburide, which I've read is deemed relatively safe to pregnant women (still a Pregnancy Category C, I believe). I saw a woman prescribed glipizide, which my coworkers had never seen before, and asked her physician's office to switch her to glyburide.

Then I have seen research that says insulin and only insulin should be initiated for these women and should be the standard medical treatment.

Not sure what to suggest to my patients...? Worried that sulfonylureas potentially crossing the placenta can cause fetal hypoglycemia and/or potential birth defects... but not sure whether insulin management is plausible/appropriate for every GDM patient I encounter...

Personally I would prefer insulin. But that's because I'm a RN, type 1 diabetic for 10 years AND a diabetes educator. So I'm biased...

Help/input would be much appreciated! Thank you.

[SteveDE]

While I haven't dealt with GDM, my first thought is what does her OB doctor say? I think in the case of pregnancy related issues the OB provider should be contacted and should know what to do, if they don't know what to do, my recommendation would be to find an OB provider for that patient that is knowledgeable and comfortable with handling GDM.

I'm an RN, as well, and while we should know and be able to recommend, I feel strongly that in cases such as pregnancy there should be a knowledgeable medical provider directly involved for mother and baby and if there isn't, she needs to find one.

[Mudwoman]

I've seen lots of GDM patient's placed on Metformin too. None of these medications have FDA approval for use with pregnant women, however, doctors are prescribing them for patients. OB docs I've talked to say there is no evidence that these oral agents cause harm and because the criteria has changed so that more women are given a diagnosis of GDM, insulin is not always appropriate either. There is too much risk of hypoglycemia.

Evidence based practice is in play here.