Pharmacotherapy for gestational diabetes

ABSTRACT

Introduction: Gestational diabetes mellitus (GDM) represents impaired carbohydrate metabolism during pregnancy and is characterized by progressive insulin resistance and compensatory hyperinsulinaemia. If inadequately treated, it may lead to fetal macrosomia and other adverse outcomes.

Areas covered: In this review, the authors summarize the current evidence from studies on the use of insulin and other agents for the treatment of women with GDM.

Expert opinion: Lifestyle management is of paramount importance for the treatment of GDM. In pharmacotherapy, insulin remains the long-established mainstay of treatment. NPH (Neutral Protamine Hagedorn) and soluble human insulin have long been established for use, but favorable experience has now also accumulated with the newer insulins (aspart, lispro, detemir). Alternatively, metformin and glyburide have been used in GDM, but they have never gained wide acceptance. Nutritional supplements based on micronutrients and bioactives (probiotics and myoinositol) have shown promising results as well. Further experience with incretin agents (DPP-4 inhibitors and GLP-1 receptor agonists) is awaited.

KEYWORDS:

• Gestational diabetes
• lifestyle
• insulin
• incretins
• therapy

Article highlights

• Adequate pharmacotherapy of gestational diabetes mellitus is needed to reduce fetal macrosomia and other adverse outcomes.

• Insulin is the most widely studied and established agent, and it still remains the mainstay of treatment.

• NPH (Neutral Protamine Hagedorn) and soluble human insulin have long been established for use, but favorable experience has now also accumulated with the newer insulins (aspart, lispro, detemir).

• Among oral antidiabetic agents, metformin and glyburide have been used in GDM, but they have never gained wide acceptance. Further experience with incretin agents (DPP-4 inhibitors and GLP-1 receptor agonists) in GDM is awaited.

• Nutritional supplements based on micronutrients and bioactives (probiotics, myoinositol and others) have shown promising favorable results as well.

This box summarizes key points contained in the article.

Declaration of Interest

M Rizzo has received grants and/or fees from Amgen Inc, AstraZeneca, Boehringer Ingelheim, Eli Lilly and Company, Meda Pharma, Merck and Co, Novo Nordisk, Roche and Servier. N Papanas has been an advisory board member of TrigoCare International, Abbott, AstraZeneca, Elpen, Merck Sharp and Dohme, Novartis, Novo Nordisk, Sanofi and Takeda. He has also participated in sponsored studies by Eli Lilly, Merck Sharp and Dohme, Novo Nordisk, Novartis and Sanofi and received honoraria as a speaker from AstraZeneca, Boehringer Ingelheim, Eli Lilly, Elpen, Galenica, Merck Sharp and Dohme, Mylan, Novartis, Novo Nordisk, Pfizer, Sanofi, Takeda and Vianex. Finally, he declares that he has received travel grants to attend conferences from and which were sponsored by TrigoCare International, AstraZeneca, Boehringer Ingelheim, Eli Lilly, Novartis, Novo Nordisk, Pfizer and Sanofi. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer Disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This manuscript was not funded or sponsored.