{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T09:17:56Z","timestamp":1780996676430,"version":"3.54.1"},"reference-count":28,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2023,7,17]],"date-time":"2023-07-17T00:00:00Z","timestamp":1689552000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000071","name":"National Institute of Child Health and Human Development","doi-asserted-by":"publisher","award":["R01 HD097778"],"award-info":[{"award-number":["R01 HD097778"]}],"id":[{"id":"10.13039\/100000071","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000038","name":"Food and Drug Administration","doi-asserted-by":"publisher","award":["5U01FD007213"],"award-info":[{"award-number":["5U01FD007213"]}],"id":[{"id":"10.13039\/100000038","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pharmacoepidemiology and Drug"],"published-print":{"date-parts":[[2023,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Purpose<\/jats:title><jats:p>Healthcare utilization databases often lack information on glycemic control, a key confounder when studying the safety of antidiabetic treatments, since patients with worse control are channeled to second\u2010line agents, in particular insulin, versus first\u2010line agents such as metformin. We evaluated whether adjustment for measured characteristics attains balance in glycemic control when comparing antidiabetic treatment strategies in pregnant women with pregestational type 2 diabetes (T2DM).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>In a US insurance claims database, we identified 3360 women with T2DM pregnant between 2004 and 2015, of whom a subset of 996 had data on hemoglobin A<jats:sub>1c<\/jats:sub> (HbA<jats:sub>1c<\/jats:sub>) levels. We selected <jats:italic>insulin only<\/jats:italic> as the comparator group and used propensity score (PS)\u2010matching on comorbidities and proxies of diabetes severity, but not on HbA<jats:sub>1c<\/jats:sub>, to adjust for confounding. We used standardized differences (st.diff) to assess balance in claims\u2010based covariates and mean HbA<jats:sub>1c<\/jats:sub> (%\u2009\u00b1\u2009SD) in the subset.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>There were imbalances in claims\u2010based covariates before PS\u2010matching, with smaller differences when both treatment strategies included insulin. After PS\u2010matching, balance was achieved in most claims\u2010based covariates (st.diff &lt;0.1). Mean HbA<jats:sub>1c<\/jats:sub> was similar before and after PS\u2010matching when both treatments included insulin (e.g., 7.1\u2009\u00b1\u20091.5 vs. 7.7\u2009\u00b1\u20091.8 and 7.1\u2009\u00b1\u20091.5 vs. 7.5\u2009\u00b1\u20091.7, respectively, for <jats:italic>metformin\u2009+\u2009insulin<\/jats:italic> vs. <jats:italic>insulin only<\/jats:italic>). Differences in mean HbA<jats:sub>1c<\/jats:sub> remained after PS\u2010matching when non\u2010insulin treatments were compared to treatments including insulin (e.g., 6.3\u2009\u00b1\u20091.1 vs. 7.6\u2009\u00b1\u20091.7 for <jats:italic>metformin only<\/jats:italic> vs. <jats:italic>insulin only<\/jats:italic>).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Balance in both claims\u2010based characteristics and glycemic control was attained after restricting the population to women with T2DM and comparing treatment strategies indicated for patients with similar diabetes severity. When comparing treatment strategies with versus without insulin, differences in glycemic control persisted after PS\u2010matching even when balance was attained for other measured characteristics.<\/jats:p><\/jats:sec>","DOI":"10.1002\/pds.5665","type":"journal-article","created":{"date-parts":[[2023,7,18]],"date-time":"2023-07-18T05:31:23Z","timestamp":1689658283000},"page":"1350-1359","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Achieving comparability in glycemic control between antidiabetic treatment strategies in pregnancy when using real world data"],"prefix":"10.1002","volume":"32","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5759-9366","authenticated-orcid":false,"given":"Carolyn E.","family":"Cesta","sequence":"first","affiliation":[{"name":"Department of Epidemiology Harvard T.H. Chan School of Public Health  Boston USA"},{"name":"Centre for Pharmacoepidemiology, Department of Medicine Solna Karolinska Institutet  Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1458-7642","authenticated-orcid":false,"given":"Sonia","family":"Hern\u00e1ndez\u2010D\u00edaz","sequence":"additional","affiliation":[{"name":"Department of Epidemiology Harvard T.H. Chan School of Public Health  Boston USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5805-8430","authenticated-orcid":false,"given":"Krista F.","family":"Huybrechts","sequence":"additional","affiliation":[{"name":"Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine Brigham and Women's Hospital and Harvard Medical School  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian T.","family":"Bateman","sequence":"additional","affiliation":[{"name":"Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine Brigham and Women's Hospital and Harvard Medical School  Boston Massachusetts USA"},{"name":"Department of Anesthesiology, Perioperative and Pain Medicine Stanford University School of Medicine  Palo Alto California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seanna","family":"Vine","sequence":"additional","affiliation":[{"name":"Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine Brigham and Women's Hospital and Harvard Medical School  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ellen W.","family":"Seely","sequence":"additional","affiliation":[{"name":"Endocrinology, Diabetes and Hypertension Division Brigham and Women's Hospital and Harvard Medical School  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8809-9898","authenticated-orcid":false,"given":"Elisabetta","family":"Patorno","sequence":"additional","affiliation":[{"name":"Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine Brigham and Women's Hospital and Harvard Medical School  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,7,17]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm6743a2"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.diabres.2018.02.023"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjdrc-2019-000759"},{"key":"e_1_2_11_5_1","doi-asserted-by":"crossref","DOI":"10.1002\/edm2.319","article-title":"The use of glucose\u2010lowering medications for the treatment of type 2 diabetes mellitus during pregnancy in the United States","volume":"5","author":"Wood ME","year":"2021","journal-title":"Endocrinol Diab Metab"},{"issue":"1","key":"e_1_2_11_6_1","first-page":"S11","article-title":"9. 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