Initiate non-insulin therapyCompared with insulin, oral Glu lowering agents are less expensive, do not require educational instruction at initiation of therapy and are preferred by most patients. According to ES Guidelines, availiable choices are glyburide and metformin. The criteria for each choice are stated bellow: R5.2a Suggest glyburide is a suitable alternative to insulin therapy for women who fail to achive sufficient glycemic control after 1 week trial of medical nutrition therapy and exercise unless:
Glyburide appears safe an effective alternative to insulin in most women with GDM though its lack of food and drug administration (FDA) appoval.
R 5.2b Suggest metformin therapy be used for glycemic control only for women who fail to achive sufficient glycemic control after 1 week trial of medical nutrition therapy and exercise and:
Is glycemic control sufficient?
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Map: Management of overt diabetes (DM) and gestational diabetes (GDM) (305)
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