Why carry out this study? Diabetes mellitus is becoming a global epidemic but it disproportionally affects poorer developing countries. Newer agents, although increasingly recognized by some international guidelines, are not always widely accessible and affordable, unlike long-standing drugs such as sulfonylureas (SUs) This review considers existing antidiabetic drugs and makes a case for appropriateness of SUs, especially newer generation SUs What was learned from the study? The newer drugs like DPP4 inhibitors, SGLT2 inhibitors and GLP-1 receptor agonists, while showing benefits, may not be affordable and accessible for many individuals in developing countries The newer generation SUs like gliclazide and glimepiride are time-tested, effective, safe and should continue to be used especially in resource-restricted settings

Recent findings demonstrate that tailored nutrition counseling and adapting certain eating patterns, supervised exercise programs aiming at achieving at least moderate level of physical activity, and interactive and monitored behavior change interventions are effective in reducing excessive GWG and PPWR. Among the pharmacologic agents, Metformin has been shown to reduce GWG. Excessive GWG and PPWR are associated with adverse maternal and neonatal outcomes. Recent evidence shows that weight during gestation and the postpartum period can be significantly reduced by more frequent nutrition counseling sessions on balanced diet focusing on healthier food choices and eating patterns, supervised moderate-intensity exercise for at least 30 min three times a week, and interactive behavior change interventions with regular feedback and follow-up. The benefits on weight are seen when these interventions are utilized together in a multimodality approach. Metformin is effective in preventing excessive GWG but has no impact on neonatal outcomes.