Picon-Cesar MJ, Molina-Vega M, Suarez-Arana M, et al. - Experts aspired to explore whether metformin could achieve the same glycemic control as insulin and similar obstetrical and perinatal results, with a good safety profile, in women with gestational diabetes not properly controlled with lifestyle changes. The MeDiGes study was a multicenter, open-label, parallel arms, randomized clinical trial conducted at two hospitals in Málaga (Spain) that enrolled women with gestational diabetes mellitus who required pharmacological treatment. Women between the ages of 18 and 45 in their second or third trimesters of pregnancy were randomly assigned to receive metformin or insulin (Detemir and/or Aspart). Between October 2016 and June 2019, 200 women were randomised, with 100 assigned to the insulin-treated group and 100 assigned to the metformin-treated group. The lower cesarean delivery rate in metformin-treated women was not associated with macrosomia, large or small for gestational age, or other pregnancy complications. Findings suggested an association of metformin treatment with a better postprandial glycemic control than insulin for some meals, a lower risk of hypoglycemic episodes, less maternal weight gain, and a low rate of failure as an isolated treatment. The majority of obstetrical and perinatal results were comparable between groups.