820 The GuMDROP study: current practices in gestational diabetes mellitus treatment in the United States

Abstract

To survey MFMs who manage patients with gestational diabetes mellitus (GDM) in order to quantify the ‘provider’s discretion’ for the transition from diet and exercise alone to pharmacotherapy. A survey of 29 questions was designed and validated with 7 cognitive interviews of GDM providers (General OB, MFM, Endocrinology). The survey was disseminated in partnership with SMFM in Special Delivery newsletter to SMFM members. 466 SMFM members completed the survey, representing 51/53 states/territories and treating an average of 15-20 patients with GDM per month. 94% regularly diagnose GDM based on two-step criteria while only 9% regularly diagnose based on one-step (2-hour 75g OGTT). 99.8% regularly initiated GDM treatment with diet, with 34% allowing 1 week, 31% allowing >1 to <2 weeks and 33% allowing 2 weeks, for it to take effect before adding pharmacotherapy. 97% considered both fasting & post-prandial values in their decision to initiate pharmacotherapy, with 44% considering fasting values more important and 55% weighing both equally (Table 1). In a typical patient with GDM, 28.8% of MFMs initiate pharmacotherapy at 20% elevated capillary blood glucose (CBG) values, and 46.5% initiate pharmacotherapy at 25% elevated CBG values. Majority initiate pharmacotherapy at 30% elevated CBG values (Figure 1). When selecting the choice of pharmacotherapy, 65.4% of MFMs would initiate therapy with insulin and 26.7% with oral antidiabetic medication. The remainder perform shared decision-making on the type of pharmacotherapy with the patient. Among MFMs that select oral antidiabetic as first line pharmacotherapy, 81.8% prescribe Metformin. 79.4% of respondents endorsed an official statement providing evidence-based recommendations for pharmacotherapy initiation for GDM would be very or moderately useful to their practice. The survey showed marked heterogeneity in the threshold of elevated CBG values prior to initiating GDM pharmacotherapy with an inflection point for the majority of MFMs adding pharmacotherapy between 25-30% elevated CBG values.View Large Image Figure ViewerDownload Hi-res image Download (PPT)