In Australia, metformin use for hyperglycaemia in pregnancy (HGiP) has increased; and is emerging as a potential co- or alternative treatment to insulin. However, use remains controversial in the community, with disparity between guidelines and accepted practice. Literature review provides evidence for efficacy and safety, in the short term, of metformin in HGiP (gestational diabetes mellitus and diabetes in pregnancy), with logistical benefits over insulin, the current gold standard.1 Health professional product information (PI), Consumer Medicines Information (CMI) and the Therapeutic Guidelines recognise pregnancy as an ‘off label’ indication and advocate caution in this vulnerable population.1 Diabex 500mg PI states “When the patient plans to become pregnant and during pregnancy, it is recommended that diabetes should not be treated with metformin but insulin should be used…..”. The companion CMI also provides unfavourable information “Do not take this medicine if you are pregnant or plan to become pregnant. The safety of Diabex in pregnant women has not been established. Insulin is more suitable …. Your doctor will replace Diabex with insulin … Do not take.” This is a concern for women prescribed metformin.
As health professionals’ duty of care is to ‘first do no harm’; it is not surprising there is anecdotal evidence of hesitancy by some GPs to prescribe and pharmacists to dispense metformin for this indication. Research highlights that beliefs and attitudes expressed by women with HGiP are strongly associated with the health care model and attitudes of the healthcare professionals they encounter.2 Absence of effective collaboration, conflicting knowledge, practices and attitudes between professional groups could contribute to uncertainty or poor adherence in these women. As the first step in problem resolution is problem identification, we have explored the scale of the problem, information and other barriers to the quality use of metformin in HGiP.