Understanding patient perspectives on glycemic control: A mixed methods study of diverse patients with gestational diabetes.

BACKGROUND: Gestational diabetes mellitus (GDM) increases risk for adverse health outcomes and disproportionately affects racial and ethnic minority populations. Achieving optimal glycemic control during pregnancy mitigates risks but requires consistent blood glucose monitoring, diet, physical activity, and, when needed, medication adherence. OBJECTIVE: To identify barriers and facilitators of GDM treatment adherence among racially and ethnically diverse patients with suboptimal glycemic control (<80% of glucose values/week within goal) or monitoring (<14 measurements/week) in their most recent GDM-affected pregnancy. METHODS: Using a convergent parallel mixed methods design guided by the Capability, Opportunity, Motivation-Behavior (COM-B) framework, we collected quantitative data using validated online survey tools and conducted racially concordant virtual focus groups. RESULTS: Forty participants (25% Asian, 18% Black, 20% Hispanic, 23% White, 15% multiracial) completed surveys; 28 joined focus groups. Self-reported adherence was 55% for glucose monitoring, 70% for diet, and 45% for physical activity. Among those prescribed medication (n=26), 85% reported taking it as prescribed, with higher adherence for insulin (90%) than oral agents (67%). Barriers included unsupportive workplaces, discomfort with fingersticks, limited time for activity, and frustration when goals were unmet despite perceived adherence. While 85% reported food security, participants wanted greater nutritional support from family and community. Preferences for holistic and less invasive management, including continuous glucose monitors, were expressed. CONCLUSION: Patients with suboptimal glycemic control or monitoring reported barriers such as workplace constraints, limited nutritional resources, and invasive treatments. Patient-centered education, community support, and expanded treatment options may improve adherence and outcomes in diverse populations with GDM.