Insulin superior to pills for pregnancy-related diabetes

 Diabetes that begins during pregnancy is best managed with insulin injections rather than oral medication, according to new research.

When dietary changes are not enough to control gestational diabetes, many patients prefer to start treatment with metformin, an inexpensive generic oral diabetes medicine, sometimes adding another oral medicine, rather than using insulin, the trial investigators noted in a report published on Monday in JAMA.

The American Diabetes Association recommends using insulin as the first-line therapy to bring blood sugar under control in gestational diabetes, while the UK’s National Institute for Health and Care Excellence recommends metformin.

In an 820-patient trial, researchers set out to prove the pills are just as good as insulin at preventing complications of diabetes during pregnancy. That turned out not to be the case.

Rates of infants born large for gestational age, a complication linked to birth injuries, were 23.9% with oral medication versus 19.9% with insulin.

Oral treatment also was associated with greater risks of dangerously low blood sugar in mothers and in newborn babies.

An editorial published with the report praised the researchers for their “valiant, yet ultimately unsuccessful, attempt” to prove that women can safely opt for the cheaper and easier-to-administer pills.

For now, it said, “insulin reigns supreme.”

https://whbl.com/2025/01/08/health-rounds-fewer-post-surgery-complications-found-in-diabetes-patients-taking-glp-1-drugs/