Changing patterns in medication prescription for gestational diabetes during a time of guideline change in the USA: a cross‐sectional study

Abstract

Objective To define patterns of prescription and factors associated with choice of pharmacotherapy for gestational diabetes mellitus (GDM), namely metformin, glyburide and insulin, during a period of evolving professional guidelines.Desing Cross-sectional study.Setting US commercial insurance beneficiaries from Market-Scan (late 2015 to 2018).Study design We included women with GDM, singleton gestations, 15-51 years of age on pharmacotherapy. The exposure was pharmacy claims for metformin, glyburide and insulin.Main outcomes Pharmacotherapy for GDM with either oral agent, metformin or glyburide, compared with insulin as the reference, and secondarily, consequent treatment modification (addition and/or change) to metformin, glyburide or insulin.Results Among 37 762 women with GDM, we analysed data from 10 407 (28%) with pharmacotherapy, 21% with metformin (n = 2147), 48% with glyburide (n = 4984) and 31% with insulin (n = 3276). From late 2015 to 2018, metformin use increased from 17 to 29%, as did insulin use from 26 to 44%, whereas glyburide use decreased from 58 to 27%. By 2018, insulin was the most common pharmacotherapy for GDM; metformin was more likely to be prescribed by 9% compared with late 2015/16, but glyburide was less likely by 45%. Treatment modification occurred in 20% of women prescribed metformin compared with 2% with insulin and 8% with glyburide.Conclusions Insulin followed by metformin has replaced glyburide as the most common pharmacotherapy for GDM among a privately insured US population during a time of evolving professional guidelines. Further evaluation of the relative effectiveness and safety of metformin compared with insulin is needed.

Risk of Adverse Pregnancy Outcomes Among Pregnant Individuals With Gestational Diabetes by Race and Ethnicity in the United States, 2014-2020

“…In contrast, the rates of cesarean delivery, LGA, and macrosomia slightly decreased over time . This finding may reflect utilization of more stringent criteria for the diagnosis of gestational diabetes and more intensive medical management, including changing patterns of preferred pharmacotherapy (more insulin use) . It is possible that these clinical interventions aimed at improved glycemic control may have resulted in less fetal overgrowth and fewer cesarean deliveries …”

“…27 This finding may reflect utilization of more stringent criteria for the diagnosis of gestational diabetes 28 and more intensive medical management, 29 including changing patterns of preferred pharmacotherapy (more insulin use). 30 It is possible that these clinical interventions aimed at improved glycemic control may have resulted in less fetal overgrowth and fewer cesarean deliveries. 6,29 Many of the observed racial and ethnic disparities in adverse outcomes have been previously noted, regardless of gestational diabetes status.…”

Patterns of Postpartum Primary Care Follow-up and Diabetes-Related Care After Diagnosis of Gestational Diabetes

“…Women up to age 51 years, the average age of menopause in the US, 23 were included given the increase in pregnancy rates in women in their 40s 24 and the increased risk of GD in women of advanced maternal age. 25 Consistent with previously published studies, 22,26,27 eligible patients were identified using claim records (or encounters) containing an International Classification of Diseases, Ninth Revision (ICD-9), International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10), or Current Procedural Terminology (CPT) code indicating the delivery of an infant (eTable 1 in Supplement 1). Using the date of the earliest claim following delivery, patients included in the study had continuous enrollment from 180 days before to 365 days after the delivery date to ensure adequate capture of follow-up.…”

“…Data on women aged 15 to 51 years old who gave birth between 2015 and 2018 were identified from MarketScan (IBM Watson Health), a large administrative database for health care research that contains deidentified data from patients with commercial health insurance or Medicare supplemental health insurance, including inpatient, outpatient, and prescription drug claims. [20][21][22] Because this database is compliant with the Health Insurance Portability and Accountability Act and contains secondary data, no informed consent was feasible or applicable. Women up to age 51 years, the average age of menopause in the US, 23 were included given the increase in pregnancy rates in women in their 40s 24 and the increased risk of GD in women of advanced maternal age.…”

Metformina frente a Diabetes Gestacional: existe eficácia?

“…Pesquisando sobre a temática abordada, percebeu-se que do final do ano de 2015 até o ano de 2018, a prescrição da metformina como tratamento da DMG aumentou consideravelmente, tornando-se cada vez mais considerada por profissionais médicos, apesar disso, ao comparar sua eficácia e segurança com a insulinoterapia, que é o tratamento padrão ouro, ainda existem muitas dúvidas (Venkatesh et al, 2022). Esse aumento de prescrição, que em 2016 foi maior do que 27%, possui relação com as restrições que existem no uso da insulina, como os custos elevados e as dificuldades apresentadas no momento da aplicação (Pazzagli et al, 2020).…”