Patient Priorities, Decisional Comfort, and Satisfaction with Metformin versus Insulin for the Treatment of Gestational Diabetes Mellitus

Authors

Kartik K. Venkatesh, Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, Ohio.
Jiqiang Wu, Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, Ohio.
Anne Trinh, Center for Health Outcomes and Policy Evaluation Studies, The Ohio State University, Columbus, Ohio.
Sharon Cross, Department of Patient Experience, The Ohio State University Wexner Medical Center, Columbus, Ohio.
Donna Rice, DiabetesSisters, Raleigh, North Carolina.
Camille E. Powe, Departments of Medicine and Obstetrics, Gynecology, and Reproductive Biology, Diabetes Unit, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
Stephanie Brindle, Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, Ohio.
Sophia Andreatta, Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, Ohio.
Anna Bartholomew, Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, Ohio.
Cora MacPherson, Department of Epidemiology and Biostatistics, George Washington University, Washington, District of Columbia.
Maged M. Costantine, Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, Ohio.
George Saade, Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Eastern Virginia Medical College, Norfolk, Virginia.
Ann Scheck McAlearney, CATALYST-The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research, The Ohio State University, Columbus, Ohio.
William A. Grobman, Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, Ohio.
Mark B. Landon, Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, Ohio.

Document Type

Journal Article

Publication Date

12-4-2023

Journal

American journal of perinatology

DOI

10.1055/s-0043-1777334

Abstract

OBJECTIVE: We compared patient priorities, decisional comfort, and satisfaction with treating gestational diabetes mellitus (GDM) with metformin versus insulin among pregnant individuals with GDM requiring pharmacotherapy. STUDY DESIGN: We conducted a cross-sectional study of patients' perspectives about GDM pharmacotherapy in an integrated prenatal and diabetes care program from October 19, 2022, to August 24, 2023. The exposure was metformin versus insulin as the initial medication decision. Outcomes included standardized measures of patient priorities, decisional comfort, and satisfaction about their medication decision. RESULTS: Among 144 assessed individuals, 60.4% were prescribed metformin and 39.6% were prescribed insulin. Minoritized individuals were more likely to receive metformin compared with non-Hispanic White individuals (34.9 vs. 17.5%;  = 0.03). Individuals who were willing to participate in a GDM pharmacotherapy clinical trial were more likely to receive insulin than those who were unwilling (30.4 vs. 19.5%;  = 0.02). Individuals receiving metformin were more likely to report prioritizing avoiding injections (62.4 vs. 19.3%; adjusted odds ratio [aOR]: 2.83; 95% confidence interval [CI]: 1.10-7.31), wanting to take a medication no more than twice daily (56.0 vs. 30.4%; aOR: 3.67; 95% CI: 1.56-8.67), and believing that both medications can equally prevent adverse pregnancy outcomes (70.9 vs. 52.6%; aOR: 2.67; 95% CI: 1.19-6.03). Conversely, they were less likely to report prioritizing a medication that crosses the placenta (39.1 vs. 82.5%; aOR: 0.09; 95% CI: 0.03-0.25) and needing supplemental insulin to achieve glycemic control (21.2 vs. 47.4%; aOR: 0.36; 95% CI: 0.15-0.90). Individuals reported similarly high (mean score > 80%) levels of decisional comfort, personal satisfaction with medication decision-making, and satisfaction about their conversation with their provider about their medication decision with metformin and insulin ( ≥ 0.05 for all). CONCLUSION: Individuals with GDM requiring pharmacotherapy reported high levels of decision comfort and satisfaction with both metformin and insulin, although they expressed different priorities in medication decision-making. These results can inform future patient-centered GDM treatment strategies. KEY POINTS: · Pregnant individuals with GDM requiring pharmacotherapy expressed a high level of decisional comfort and satisfaction with medication decision making.. · Individuals placed different priorities on deciding to take metformin versus insulin.. · These results can inform interventions aimed at delivering person-centered diabetes care in pregnancy that integrates patient autonomy and knowledge about treatment options..

APA Citation

Venkatesh, Kartik K.; Wu, Jiqiang; Trinh, Anne; Cross, Sharon; Rice, Donna; Powe, Camille E.; Brindle, Stephanie; Andreatta, Sophia; Bartholomew, Anna; MacPherson, Cora; Costantine, Maged M.; Saade, George; McAlearney, Ann Scheck; Grobman, William A.; and Landon, Mark B., "Patient Priorities, Decisional Comfort, and Satisfaction with Metformin versus Insulin for the Treatment of Gestational Diabetes Mellitus" (2023). GW Authored Works. Paper 4016.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/4016

Department

Epidemiology