“It’s a Very Big Burden on Me”: Women’s Experiences Using Insulin for Gestational Diabetes

Abstract

Objectives Gestational Diabetes Mellitus (GDM) affects hundreds of thousands of women each year. Many require medications to manage their blood glucose levels. Only insulin is approved by the U.S. Food and Drug Administration for use in pregnancy. While other medications can be used, their safety remains controversial. Few studies have examined women's lived experience of using insulin for GDM. Our objective in this study was to foreground the voices of women speaking about their treatment experience. Methods We conducted two focus groups including 16 women treated for GDM with medications, primarily insulin. Topics included women's experiences with GDM diagnosis and treatment including concerns about risks and benefits of treatments. Transcripts were analyzed using an inductive coding approach. Results Many women had negative experiences with insulin use, such as feeling that they had no voice in treatment decisions, and received inadequate information about insulin, including about the impact it would have on their daily lives. Many continued to have difficulty managing their blood sugar once on insulin, and they worried about the short term and long term health effects of insulin on themselves and their babies. They wanted more information about non-insulin treatment options as well as more social support. Conclusion In our sample of women with GDM, insulin treatment resulted in negative experiences with emotional and experiential impacts lasting beyond pregnancy. There is a need for more research on other medications for GDM, so that women can have access to more treatment options and better information to guide their choices.

Experiences of lifestyle change among women with gestational diabetes mellitus (GDM): A behavioural diagnosis using the COM-B model in a low-income setting

“…According to the literature, concern for the baby is the strongest motivating factor for behaviour change during pregnancy [18, 40] and in our study provided motivation to make major lifestyle adjustments at any cost, including resisting cravings for unhealthy food and enduring the side effects of medication. Some respondents described negative experiences with antidiabetic therapy in keeping with previous reports that women with GDM find insulin use overwhelming and burdensome [16, 41, 51]. Yet in comparison to dietary modification, others prefer insulin use to manage GDM [40].…”

“…Several qualitative studies have explored women’s perspectives on GDM and lifestyle related behaviour change in North America and Europe [16–21]. However, studies on women’s lived experiences of GDM in LMICs are still lacking [22, 23].…”

Improving Safe Use of Medications During Pregnancy: The Roles of Patients, Physicians, and Pharmacists

“…Findings from this study support and expand upon previous literature. Previous research exploring patient–provider communication about medication safety during pregnancy elucidated barriers facing patients, physicians, and pharmacists (Eisenberg et al, 2010; Figueroa Gray et al, 2017; Hammer & Burton-Jeangros, 2013; M. A. Morgan et al, 2010; Obican & Scialli, 2011; Santucci et al, 2010; Schwarz et al, 2009).…”

“…These cultural trends have shifted the emphasis from the pregnant woman as the primary patient to the health of the fetus, above all. For example, in one study about insulin use to treat gestational diabetes, women reported feeling a “loss of control” over decisions in their care, and perceived the use of “scare tactics” in interactions with providers (Figueroa Gray, Hsu, Kiel, & Dublin, 2017). …”

The Medication Experience: A Concept Analysis

“…Furthermore, the medication experience involves the patient's reliance on and trust in the healthcare system and its providers. Not only do providers allow access to medications, but patients also need more information to feel comfortable about medication use [12,15,26,30,31,42,67]. Patients need a trusting relationship [27,36,39,40,66] with providers to engender a sense of security about their medications [11,44,52,72].…”