OBJECTIVE: To describe trends and identify factors associated with choice of pharmacotherapy for gestational diabetes (GDM) from 2000–2011 using a healthcare claims database.
METHODS: This was a retrospective cohort study of a large nationwide population of commercially insured women with GDM and pharmacy claims for glyburide or insulin before delivery, 2000–2011. We excluded women younger than 15 years or older than 50 years, those with prior noninsulin-dependent diabetes mellitus, or those who had multiple gestations. We estimated trends over time in the use of glyburide compared with insulin and prevalence ratios and 95% confidence intervals (CIs) for the association between covariates of interest and treatment with glyburide compared with insulin.
RESULTS: We identified 10,778 women with GDM treated with glyburide (n=5,873) or insulin (n=4,905). From 2000 to 2011, glyburide use increased from 7.4% to 64.5%, becoming the more common treatment in 2007. Women less likely to be treated with glyburide were those with metabolic syndrome (prevalence ratio 0.71, 95% CI 0.50–0.99), hyperandrogenism (prevalence ratio 0.77, 95% CI 0.62–0.97), polycystic ovarian syndrome (prevalence ratio 0.88, 95% CI 0.78–0.99), hypothyroidism (prevalence ratio 0.89, 95% CI 0.83–0.96), or undergoing infertility treatment (prevalence ratio 0.93, 95% CI 0.86–1.02). The probability of receiving glyburide decreased by 5% for every 10-year increase in maternal age (prevalence ratio 0.95, 95% CI 0.91–0.99). Among women prescribed with glyburide, 7.8% switched or augmented to a different drug class compared with 1.1% of insulin initiators.
CONCLUSION: Glyburide has replaced insulin as the more common pharmacotherapy for GDM over the past decade among those privately insured. Given its rapid uptake and the potential implications of suboptimal glucose control on maternal and neonatal health, robust evaluation of glyburide's relative effectiveness is warranted to inform treatment decisions for women with gestational diabetes.
LEVEL OF EVIDENCE: II
Among women with employer-based insurance in the United States, glyburide is used more frequently than insulin to treat gestational diabetes.
Department of Epidemiology, Gillings School of Global Public Health, and the Department of Obstetrics and Gynecology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, and the Department of Pediatrics, Duke Clinical Research Institute, Duke University, Durham, North Carolina.
Corresponding author: Michele Jonsson Funk, PhD, Department of Epidemiology, CB #7531, University of North Carolina at Chapel Hill, 104B Market Street, Chapel Hill, NC 27599; e-mail: firstname.lastname@example.org.
Dr. Castillo is currently a joint postdoctoral fellow in the Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, and the Center for Health Research, Geisinger Health System, Danville, Pennsylvania.
Dr. Jonsson Funk is supported by grant number K02HS017950 from the Agency for Healthcare Research and Quality (Michele Jonsson Funk, Principal Investigator).
The authors thank Erica Berggren of Thomas Jefferson University Hospital for suggestions on the study design for this research and Virginia Pate for her assistance with programming.
Presented at the 29th International Conference on Pharmacoepidemiology and Therapeutic Risk Management, August 25–28 2013, Montreal, Canada.
The content is solely the responsibility of the authors and does not necessarily represent the official views of the Agency for Healthcare Research and Quality.
Financial Disclosure Dr. Jonsson Funk and Dr. Stürmer receive salary support from the Center for Pharmacoepidemiology, which is currently funded by unrestricted grants from GlaxoSmithKline, Merck, and UCB. Dr. Jonsson Funk is supported by grant number K02HS017950 from the Agency for Healthcare Research and Quality (Michele Jonsson Funk, Principal Investigator). Dr. Stürmer receives investigator-initiated research funding and support as Principal Investigator (R01 AG023178) and Co-Investigator (R01 AG042845) from the National Institute on Aging and as Co-Investigator (R01 CA174453) from the National Cancer Institute at the National Institutes of Health and as Principal Investigator of a Pilot Project from the Patient Centered Outcomes Research Institute. He also received research funding as Principal Investigator of the UNCDEcIDE Center from the Agency for Healthcare Research and Quality. Dr Stürmer receives salary support from the Center for Pharmacoepidemiology (current members: GlaxoSmithKline, UCB BioSciences, Merck) and research support from pharmaceutical companies (Amgen, Genentech, Merck, Sanofi) to the Department of Epidemiology, University of North Carolina at Chapel Hill. M. Alan Brookhart receives investigator-initiated research funding from the National Institutes of Health (R01 AG042845, R21 HD080214, R01 AG023178) and through contracts with the Agency for Healthcare Research and Quality's DEcIDE program and the Patient Centered Outcomes Research Institute. He has also received research support from Amgen and has sat on advisory boards for Amgen, Merck, and Pfizer (honoraria received by institution). He has received consulting fees from RxAnte, Inc and World Health Information Science Consultants, LLC. He has received investigator-initiated grant support from Amgen and has served as a scientific advisor for Pfizer, Amgen, Merck, and Rockwell Medical but has not accepted personal compensation for this service (honoraria declined, received by institution, or donated). Dr. Benjamin has received research grants from Astellas Pharma US, AstraZeneca, and UCB Pharma that support the expenses associated with projects in Duke University Health System under his direction. He receives personal income outside of university salary for consulting or other noncontinuing medical education services from Astellas Pharma US, Biosynexus, Cempra, Cubist Pharmaceuticals, Johnson & Johnson Pharmaceutical Research and Development, Merck & Co, Pfizer, and The Medicines Company. The other authors did not disclose any potential conflicts of interest.