Abstract
AimContinuous use of antidiabetic medication, especially insulin, is crucial for diabetes management. In pregnancy, adherence to medication is generally low and may also be associated with lower socioeconomic status. However, little is known about discontinuation of insulin in pregnant women and the potential role of socioeconomic factors. Therefore, this study aims to measure the associations between socioeconomic factors and insulin discontinuation during pregnancy in women using insulin prior to the start of pregnancy in Sweden.Subjects and methodsThis cohort study identified pregnancies recorded in the Swedish Medical Birth Register from 2006 to 2016 in women receiving insulin prior to the start of pregnancy (N = 6029). Discontinuation of insulin was defined as not receiving a refill within 120 days from the previous refill. Associations between discontinuation and socioeconomic factors were investigated via logistic regression. Sensitivity analyses were performed using different definitions of discontinuation.ResultsWomen discontinued insulin use in 34.2% of pregnancies. The odds ratios (ORs) of discontinuation of insulin were 1.17 [95% confidence interval (CI): 1.01–1.37] for women with lower household disposable incomes and 1.14 (95% CI: 1.01–1.29) for women with lower educational levels. When testing a change in the maximum refill gap from 91 days to 180 days, women with lower educational levels and those born in non-Nordic countries showed greater associations with discontinuation.ConclusionThe definition of discontinuation affects the level of association of socioeconomic factors with discontinuation. Nevertheless, discontinuation of insulin is common in Sweden, especially in the lower socioeconomic groups. The socioeconomic inequality in insulin use behavior is worth noting.
Highlights
Pre-gestational diabetes mellitus is an increasingly common condition among pregnant women (Bardenheier et al 2015)
Data from the Swedish Prescribed Drug Register (PDR), the Longitudinal Integration Database for Health Insurance and Labor Market Studies (LISA by Swedish acronym), the Swedish Medical Birth Register (MBR), and the Swedish National Patient Register (NPR) were linked using the unique individual identification number provided to each resident upon birth or immigration
After adjusting for maternal age, Body mass index (BMI), parity, smoking, and diabetes subtype, the odds ratios (ORs) was 1.14 for women with 2 or 3 years of upper secondary school education compared with women with university or other higher education, while there were no increased odds for women with the lowest level of education
Summary
Pre-gestational diabetes mellitus is an increasingly common condition among pregnant women (Bardenheier et al 2015). Welfare 2015), including recommendations such as diet and lifestyle modification and antidiabetic medication (ADM). Guidelines recommend continuing insulin as treatment for pre-gestational diabetes during pregnancy (American Diabetes Association 2018; Swedish National Board of Health and Welfare 2015, 2018). Oral hypoglycemic agents are increasingly being used, though insulin remains the most common ADM used in pregnancy (Cesta et al 2019)
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