Postpartum Use of Weight Loss and Metformin for the Prevention of Type 2 Diabetes Mellitus: a Review of the Evidence

Purpose of review As many as 70% of patients diagnosed with gestational diabetes mellitus (GDM) will go on to develop type 2 diabetes (T2DM) within their lifetimes. Implementing strategies to mitigate this progression in the postpartum period when patients are already connected to care is essential in optimizing lifelong health for our patients. Both lifestyle modification and metformin have been investigated as options to reduce type 2 diabetes risk in patients with a history of GDM. Recent findings The current model for postpartum testing and care of patients with GDM has been shown to have poor uptake rates. Similarly, intervening with lifestyle modification postpartum has not resulted in significant diabetes risk reduction in prospective studies. Metformin is known to decrease insulin resistance and is also associated with weight loss. Data from large prospective studies has indicated that metformin may be a useful addition to lifestyle modifications to prevent progression to diabetes, but additional studies are needed specifically in postpartum individuals. Metformin is a safe in the postpartum period and may reduce diabetes risk if started soon after delivery in individuals with GDM, but additional studies are needed to determine which individuals with GDM are most likely to benefit from this medication.