When diet fails: insulin and oral hypoglycemic agents as alternatives for the management of gestational diabetes mellitus.

The principal approach for attaining glycemic control in gestational diabetes mellitus is diet, with the addition of insulin or oral hypoglycemic agents when needed. The purpose of this review is to provide an overview for the understanding of management guidelines that have been validated by appropriately conducted research trials. The similarity between gestational diabetes mellitus and type 2 diabetes is highlighted. Criteria for insulin initiation as well as the role of a hypoglycemic agent as a potential alternative to insulin are discussed.