JAMA

Oral glucose-lowering agents vs. insulin for gestational diabetes

January 8, 2025

Study details: This randomized, open-label noninferiority trial was conducted at 25 Dutch centers from June 2016 to November 2022, involving 820 pregnant individuals with gestational diabetes and singleton pregnancies. Participants were randomized to receive either metformin (with glyburide added if needed) or insulin after failing to achieve glycemic control with dietary changes.

Results: Among the participants, 23.9% of infants in the oral glucose-lowering medication group were born large for gestational age, compared with 19.9% in the insulin group (absolute risk difference, 4.0%; 95% confidence interval [CI], -1.7% to 9.8%; P = .09 for noninferiority). This difference didn’t meet the prespecified criteria for noninferiority. Maternal hypoglycemia occurred in 10.9% of pregnant individuals treated with insulin vs. 20.9% of those treated with oral agents, resulting in an absolute risk difference of 10% (95% CI 3.7%-21.2%).

Clinical impact: These findings suggest that oral glucose-lowering agents may not be as effective as insulin in preventing large-for-gestational-age infants in gestational diabetes. However, further research is needed to explore the long-term outcomes and safety.

Source:

Rademaker D, et al; SUGAR-DIP Study Group. (2025, January 6). JAMA. Oral Glucose-Lowering Agents vs Insulin for Gestational Diabetes: A Randomized Clinical Trial. https://pubmed.ncbi.nlm.nih.gov/39761054/