A pregnant woman is diagnosed with gestational diabetes mellitus (GDM) by DIPSI criteria at 24 weeks. Fasting blood glucose is 95 mg/dL and 2-hour post 75 g OGTT glucose is 155 mg/dL. After 2 weeks of dietary modification, 2-hour post-meal glucose is consistently 138–145 mg/dL. What is the NEXT step?
- A Continue dietary modification for another 4 weeks
- B Start metformin 500 mg BD which is preferred over insulin in GDM
- C Initiate insulin therapy as pharmacological intervention is required ✓
- D Increase dietary restriction and retest in 4 weeks before considering medication
Correct answer: C. Initiate insulin therapy as pharmacological intervention is required
Explanation
The target 2-hour post-meal glucose in GDM is <120 mg/dL. Consistently elevated levels of 138–145 mg/dL despite 2 weeks of medical nutrition therapy indicate failure of dietary management, and insulin therapy should be initiated. Insulin is the first-line pharmacological therapy for GDM in most international guidelines (ADA, ACOG) due to its established safety in pregnancy and its inability to cross the placenta in significant amounts. Metformin is increasingly used as an alternative to insulin for GDM, but insulin remains the preferred choice in most guidelines.
Reference: Williams Obstetrics, 26th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.