(663) Hypoglycemic medication adherence in women with gestational diabetes mellitus

Friday, February 10, 2023

10:30 AM – 12:00 PM

Objective: To examine the association of community-level social vulnerability with adherence to hypoglycemic medications for Gestational Diabetes (GDM) treatment.

Study Design: We examined medication adherence among a retrospective cohort of pregnant patients with GDM enrolled in Tennessee Medicaid who delivered between 2007-2019. We included patients filling a prescription for metformin, glyburide, or insulin 30 days or more before delivery. Medication adherence was calculated as the proportion of days covered by a medication, estimated using pharmacy fill data, including time from GDM medication initiation to delivery. We used the CDC Social Vulnerability Index (SVI), defined at the census tract level, to assign a social vulnerability value to each patient (ranging from 0 (low) to 100 (high)). We modeled the association between adherence and SVI, assessed continuously, using linear regression and adjusting for a priori-selected confounders. Secondary analyses explored the association between SVI subthemes and adherence.

Results: Of the 5,416 pregnant patients, glyburide was most commonly filled (41%) followed by metformin (34%) and insulin (25%) (Table 1). Median adherence for all medications was 91.2% (IQR 71.4% – 100%). A one unit increase in SVI was associated with a non-significant 1.99% increase in medication non-adherence (95% CI: -0.08 – 4.07). Findings were similar for all SVI subthemes except for Housing and Transportation (measure of level of crowded housing and vehicle access), for which a one unit increase in Housing and Transportation value was significantly associated with a 2.37% increase in non-adherence (95% CI: 0.36 – 4.29). In all models, younger age, increased parity, and Insulin compared to glyburide were also associated with decreased medication adherence.

Conclusion:

Adherence to hypoglycemic medication treatment for GDM was high among pregnant patients regardless of social vulnerability status. The impact of crowded housing and poor transportation on medication adherence warrants further investigation.

Primary & Presenting Author(s)

Amelie Pham, MD (she/her/hers)
Fellow
Vanderbilt University Medical Center
Nashville, Tennessee, United States

Coauthor(s)

AW
Andrew Wiese, MPH, PhD
Assistant Professor
Vanderbilt University Medical Center
Nashville, Tennessee, United States
AS
Andrew Spieker, PhD
Assistant Professor of Biostatistics
Vanderbilt University Medical Center
Nashville, Tennessee, United States
LA
Leech Ashley, MS, PhD
Vanderbilt University
Nashville, Tennessee, United States
SP
Sharon Phillips, MSPH
Associate in Biostatistics
Vanderbilt University Medical Center
Nashville, Tennessee, United States
Margaret Adgent, MSPH, PhD (she/her/hers)
Research Associate Professor
Vanderbilt University Medical Center
Nashville, Tennessee, United States
CG
Carlos Grijalva, MD, MPH
Associate Professor
Vanderbilt University Medical Center
Nashville, Tennessee, United States
SO
Sarah S. Osmundson, MD,MSCR
Associate Professor
Vanderbilt University
Nashville, Tennessee, United States