Choice of glucose-lowering agent

• The GDG acknowledged that there is no clear difference in benefits and harms between metformin and insulin during pregnancy (see below), and clinical practices and availability of medications are highly variable. The choice of glucose-lowering agent for pregnant women with type 2 diabetes will be based on the woman’s experiences of medication before becoming pregnant, her glycaemic control during pregnancy, local availability and expertise, and her values and preferences.
• The GDG noted that many blood-glucose lowering agents are either not recommended for use in pregnancy or do not have adequate safety data in pregnancy (e.g. glucagon-like peptide-1 receptor agonists [GLP-1RA] and sodium-glucose transport protein 2 [SGLT2] Inhibitors). Dose of glucose-lowering agent
• The GDG acknowledged that, although the evidence on type 2 diabetes during pregnancy is limited, increased monitoring and/or intensity of glycaemic management may be required. Continuous subcutaneous insulin infusion may also be a consideration, as available.