INS and Hyperglycemia: Trials do not always report GDM diagnostic criteria clearly, and this is important considering the potential influence on GDM population size and the magnitude of effect.16 44 Our detailed review, including only evidence from RCTs, provides some support for a ‘step up approach’ in the treatment of hyperglycaemia, from dietary interventions, through addition of metformin (in preference to glibenclamide (glyburide)) through addition of insulin.