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Review analyses the best treatments for gestational diabetes mellitus

By Colin Kenny, Editor – Diabetes Distilled
Gestational diabetes mellitus (GDM) can have short- and long-term complications for the mother and her infant. Investigators sought to establish the effectiveness of different insulin regimens, compared with oral antidiabetes therapies and non-pharmacological interventions. They carried out a Cochrane review of relevant randomised controlled trials and found that there are minimal harms associated with the effects of treatment with either insulin or oral antidiabetes therapies. The choice to use one or the other may be down to physician or maternal preference, availability, or the severity of GDM.

The investigators carried out a Cochrane review of relevant randomised controlled trials comparing insulin with oral therapy or non-pharmacological interventions. They included 53 relevant studies, which reported data for 7381 women. Forty-six of these studies also reported data for infants (N=6435). They found that the quality of the evidence ranged from moderate to very low quality, reflecting the difficulty of doing these trials.

The available evidence suggests that there are very few differences in short-term outcomes for the mother and baby between treatment with injected insulin and treatment with oral medication. There is not enough evidence yet for long-term outcomes. Decisions about which treatment to use could be based on discussions between the doctor and the mother regarding individual preferences. Further research is needed to explore optimal insulin regimens for women with GDM. Future studies should aim to report long-term as well short-term outcomes for mothers and their babies.
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