Metformin as First-Line Therapy in Gestational Diabetes Mellitus (GDM)
A Comparison Across DIPSI, NICE, SIGN, FIGO, Endocrine Society, SMFM, and ADA Guidelines
Rachna Jain*
*Consultant Obstetrician & Gynecologist, MBBS, DGO, Jain Hospital & Research Center, Kanpur, India. Email:
[email protected]
Submitted: 28 June 2026; Accepted: 18 July 2026; Published: 24 July 2026
DIPSI (Diagnosis & Management of Gestational Diabetes Mellitus, 2021 — Diabetes in Pregnancy Study Group India, published via FOGSI) does not list metformin as first-line. Insulin is the drug of choice and is recommended for use in pregnancy as it does
not cross the placenta (FOGSI/DIPSI, 2021). [1] Metformin has a secondary role: it is useful for obese women or for women who are already on it, but it should not be prescribed for women with GDM if there is significant organ dysfunction, hypertensive
disorders of pregnancy, fetal growth restriction, or other high-risk factors (FOGSI/DIPSI, 2021). [1]
