Medical Optimization of Management of Type 2 Diabetes Complicating Pregnancy (MOMPOD)

Inclusion Criteria:

- Maternal age 18-45 years

- Singleton pregnancy with no known fetal anomalies

- Gestational age between 10weeks 0 days and 20 weeks 6 days by menstrual dating
confirmed by ultrasound, or ultrasound alone

- Clinical diagnosis of preexisting T2DM requiring medical treatment (oral agent or
insulin)

- Clinical diagnosis of diabetes diagnosed between 10 weeks and < 20 weeks 6 days
gestation

- Willing to start insulin therapy and discontinue oral hypoglycemic pills other than
study pills

- Able to swallow pills

Exclusion Criteria:

- Clinical diagnosis of pre-existing renal disease, defined as creatinine > 1.5 mg/dL

- Clinical history of lactic acidosis

- Known allergy to metformin

- Participation in another study that could affect primary outcome

- Delivery planned at non-MOMPOD study locations

- Unwillingness to use insulin treatment or follow prenatal care doctor's instructions
for insulin and blood glucose monitoring