The DECIDE trial (DECIDE: A Comparative Effectiveness Trial of Oral Metformin Versus Injectable Insulin for the Treatment of Gestational Diabetes; ClinicalTrials.gov identifier: NCT06445946), a large, pragmatic, open-label RCT comparing the effectiveness, safety and patient experience of oral metformin versus insulin in managing GD, is currently underway.54 It also investigates patient preferences and the impact on offspring health up to 2 years after birth. The gene discussed is INS; the disease is gestational diabetes.