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Prescribing Patterns of Metformin in High-risk Patients with Prediabetes
Daniel L Stirling1, Ifeanyi Onor2, Daniel Sarpong3
1Daniel L. Stirling is affiliated with Xavier University of Louisiana, New Orleans, LA.
Insights
Metformin prescribing for prediabetes is low, especially for high-risk groups. Provider education is needed to increase metformin use and prevent type 2 diabetes progression.
Area of Science:
- Endocrinology
- Metabolic Disorders
- Pharmacotherapy
Background:
- Prediabetes affects a significant portion of the population.
- Early intervention can prevent progression to type 2 diabetes mellitus (DM).
- Metformin is a recommended pharmacotherapy for prediabetes in specific patient populations.
Purpose of the Study:
- To examine metformin prescribing rates in prediabetes patients meeting specific criteria (age < 60, BMI > 35 kg/m2, or history of gestational diabetes mellitus).
- To assess the time from prediabetes diagnosis to metformin initiation.
- To explore correlations between metformin initiation and additional DM risk factors.
Main Methods:
- Retrospective cohort study at a single center.
- Included patients with prediabetes (HbA1c 39-46 mmol/mol or 5.7-6.4%).
- Data collected from January 2012 to September 2013.
Main Results:
- Overall metformin initiation rate was 8.1% (13 out of 160 patients).
- Initiation rates varied by group: 0% for history of GDM, 9.0% for age < 60, and 17.5% for BMI > 35 kg/m2.
- Analysis of time to initiation and correlation with other risk factors was performed.
Conclusions:
- Metformin prescribing rates for prediabetes do not align with current clinical guidelines.
- Increased provider education is essential to improve metformin utilization.
- Timely metformin initiation may delay or prevent progression to type 2 DM.
Aims:
The primary objective of this study is to examine the rates of metformin prescribing in patients with prediabetes who are either less than 60 years of age, have a BMI greater than 35 kg/m2, or women with a history of gestational diabetes mellitus (GDM). Secondary objectives include: 1) examination of the time from diagnosis of prediabetes to the initiation of metformin and 2) if metformin initiation status and length of time correlates to the patient having any other additional diabetes mellitus (DM) risk factors.
Methods:
This was a single center, retrospective cohort study. This study included all patients with prediabetes, defined as having hemoglobin A1c (HbA1c) of 39 through 46 mmol/mol (5.7-6.4 percent), who were patients at the Interim LSU Hospital and Clinics from January 2012-September 2013.
Results:
There were a total of 13 patients out of 160 patients in the study population who were prescribed metformin for an overall metformin initiation rate of 8.1 percent. The metformin initiation rate for the three individual groups; history of GDM, aged less than 60 years, and BMI greater than 35 kg/m2 were 0 percent, 9.0 percent, and 17.5 percent respectively.
Conclusion:
Metformin initiation rates in patients with prediabetes are not in accordance with current recommendations, and provider education is necessary to increase rates to delay or prevent the progression of prediabetes to type 2 Diabetes Mellitus.
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