Tirzepatide Use and Diabetes Management in Pregnancy

Clinical Management Algorithm

The American Diabetes Association recommends transitioning to insulin therapy immediately upon pregnancy confirmation or suspicion, as insulin has established safety data and is recommended as first-line treatment for gestational diabetes and pre-existing diabetes in pregnancy 1, 2
Insulin is the preferred medication for treating hyperglycemia in pregnancy, with established safety and efficacy, and should be used as the gold standard for treating hyperglycemia during pregnancy 1, 2

The American Diabetes Association recommends targeting an A1C <6% (42 mmol/mol) if achievable without significant hypoglycemia, and a CGM time-in-range goal >70% (63-140 mg/dL) for type 1 diabetes 1, 2
Metformin and glyburide should not be used as first-line agents as both cross the placenta, and other oral and non-insulin injectable glucose-lowering medications (including GLP-1 receptor agonists like tirzepatide) lack long-term safety data 1, 2