Barriers and facilitators to insulin management in pregnant people with gestational diabetes mellitus: A qualitative study.

OBJECTIVE: To explore barriers and facilitators to gestational diabetes mellitus (GDM) self-management and insulin use, aiming to inform future interventions, in a diverse population of pregnant people. STUDY DESIGN: In this ancillary study of an ongoing randomized controlled trial testing thresholds for insulin initiation for GDM, participants in the parent trial were recruited from February 2023 to January 2024. Purposive sampling was used to recruit diverse participants with respect to age, race, ethnicity, insurance status, parity, and insulin use. In-depth semi-structured interviews were conducted after 34 weeks' gestation. Interview guides addressed topics related to pregnancy with GDM; this analysis focused on experiences with insulin and adherence to their treatment plan. 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. Analysis identified key barriers and facilitators to treatment plan adherence. 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 with insulin, 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 fetus. 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 recommendation to use insulin caused a strong negative reaction, but hands-on education provided by the medical team helped to alleviate fear and other barriers.