Is metformin safe and effective for treating gestational diabetes in patients who fail diet management?

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Evidence-Based Answer

Metformin is at least as effective as insulin for most outcomes when used as initial therapy for patients with gestational diabetes, mellitus (GDM) who fail diet management. Metformin is associated with a significant increase in premature deliveries, although no significant differences in other adverse neonatal outcomes (SOR: A, systematic reviews of RCTs and observational studies). About a quarter of GDM patients treated with metformin (or glyburide) eventually require insulin (SOR: A, systematic review of RCTs).

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