(130) Fear of insulin and other experiences with gestational diabetes mellitus management – a qualitative study

To understand the experiences of patients with gestational diabetes mellitus (GDM) using qualitative methods to explore barriers and facilitators to GDM self-management and insulin use, aiming to inform future interventions.

Study Design:

In this ancillary study of an ongoing randomized controlled trial of thresholds for insulin initiation and titration for GDM, participants were recruited from 2/2023 to 1/2024 using purposive sampling, aiming for diversity with respect to age, race, ethnicity, insurance status, parity, and insulin use. In-depth semi-structured interviews were conducted after 34 weeks’ gestation and again postpartum within a week of childbirth. Interview guides covered 1) experience with and knowledge about GDM, 2) self-efficacy and social support, 3) experience with insulin, 4) adherence and persistence to their treatment plan, and 5) birth experience. Transcripts were analyzed using a reflexive thematic analysis approach to develop themes.

Results:

Of 20 participants, 80% had GDM for the first time and 50% required insulin treatment (Table 1). Initial coding of transcripts identified key barriers and facilitators to treatment plan adherence (Table 2). Barriers included: 1) fear of insulin (“When I was first told about it, I threw a tantrum… I do not like needles, and that's all I could think about.”), 2) the time and cognitive effort to learn self-management, 3) managing emotions related to GDM diagnosis and self-management, and both 4) jobs and 5) family/friends unawareness made it difficult to manage GDM as recommended. Facilitators included 1) training from the medical team (“once I saw my insulin pen, it wasn't that bad.”), 2) support from family/friends, and 3) concern for the well-being of the baby.

Conclusion:

Self-management of GDM requires substantial social and institutional support, learning, and adjusting to a new lifestyle in a short period of time. For some, the initial recommendation to use insulin caused a strong negative reaction, but hands-on education provided by the medical team helped to alleviate that fear.