Insulin is recommended as the first-line treatment and metformin (and rarely glyburide) may be an alternative if insulin is unable to be used, according to several associations, including the American Diabetes Association (ADA)12, the American College of Obstetricians and Gynecologists (ACOG)13, the Canadian Diabetes Association (CDA)14, and the Korean Diabetes Association (KDA)11. This evidence concerns the gene INS and diabetes mellitus.