Table 3.

Reasons for not prescribing or dispensing metformin for patient(s) with gestational diabetes

Reasons	n (%)	Example of comments
Not directly involved in the treatment of GDM	38 (26.0)	-
Not the current practice or standard protocol in the department/ setting/institution	20 (13.7)	“Not routinely used as treatment option in this center for GDM”
		“Not practiced in this institution”
		“Patients do well on insulin. I need to change practice and start prescribing after the CPG but have not done so. Still skeptical”
Metformin is not the first line for GDM	11 (7.5)	“First-line treatment for GDM is insulin and usually is well tolerated”
Better glycemic control with insulin	10 (6.8)	“Better glycemic control has been achieved with insulin alone”
Concern about the contraindication and safety profile of metformin	10 (6.8)	“Contraindicated”
		“Increase risk of birth defect”
		“Previously metformin said to be teratogenic”
		“Uncertainty about safety”
		“I thought metformin cannot be given to pregnant ladies”
Not familiar with metformin use in GDM	9 (6.2)	“Not familiar”
		“Not comfortable to use as first line, for the time being”
		“Previously not yet established evidence/recommendation”
Others	18 (12.3)	“Mostly doctor prescribed insulin straight away for GDM patient” “use insulin only”
Total	146 (79.3)

GDM: Gestational diabetes mellitus, CPG: Clinical practice guideline