Introduction and Objective: Delayed access to insulin (DAI) during pregnancy can have a major impact on effective diabetes management, posing risks to mother and infant. We sought to assess the frequency of DAI (≥ 7 days) in pregnant women and identify associated factors.Methods: Of 1262 pregnant women aged ≥18 with GDM or pre-existing T2DM who were newly prescribed insulin between 2018 and 2024, we randomly selected 303 women for detailed chart review with equal distribution across calendar years. We determined the Social Vulnerability Index (SVI) tertiles by census tract.Results: Of the 303 women, 15.5% experienced DAI. Compared to the non-delayed group, there was a higher proportion of high SVI, Black race, single status, need for interpreter and public insurance in the delayed group (Table 1). In a multivariable logistic regression model, Black race (OR=6.01, p<0.001) high SVI (OR=2.07, P=0.05) and prescriptions during 2022-2024 vs. 2018-2021 (OR = 2.35, p= 0.027) remained significant predictors of DAI. Delays were primarily due to insulin coverage (47%), e.g., prior authorization for nonpreferred brand, and patient concerns, e.g., fear of side effects (27.6%). There were more insulin coverage issues and fewer patient concerns in 2022-2024 than in 2018-2021.Conclusion: We found that DAI is common during pregnancy, especially among black women, has increased in frequency and is commonly due to insurance coverage issues.
G. Rios-Ortega: None. S. Trabelsi: None. M. Fatima: None. D.C. Simonson: Stock/Shareholder; GI Windows. Consultant; Phase V Technologies. E.W. Seely: None. M.E. McDonnell: Research Support; Dexcom, Inc.
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