In GDM patients with pre-pregnancy BMI ≥ 29 kg/m2 carrying the rs10830963 risk G allele, this gap might become so substantial that the endogenous insulin secretion is no longer adequate to cover the increased insulin need despite the MNT and lifestyle intervention and the administration of exogenous insulin becomes necessary to provide the appropriate glycemic control. The gene discussed is INS; the disease is gestational diabetes.