Insulin and other treatment alternatives in gestational diabetes mellitus

Insulin has become the gold standard of gestational diabetes treatment when diet therapy fails to achieve targeted levels of glycemic control. Although numerous studies have addressed the issue of insulin and diet therapies, to date there is a lack of consensus concerning which patients should be treated with insulin and the method for blood glucose evaluation. This article reviews existing literature and published consensus statements regarding management of gestational diabetes. Criteria for insulin initiation such as fasting plasma glucose level and fetal parameters (abdominal circumference) are also examined. The historic and current data regarding oral hypoglycemic agents as alternatives for insulin therapy are addressed.