Prediabetes affects 1 in 3 Americans. Both intensive lifestyle intervention and metformin can prevent or delay progression to diabetes. Over the past decade, lifestyle interventions have been translated across various settings, but little is known about the translation of evidence surrounding metformin use.
To examine metformin prescription for diabetes prevention and patient characteristics that may affect metformin prescription.
Retrospective cohort analysis over a 3-year period.
Employer groups that purchased health plans from the nation's largest private insurer.
A national sample of 17 352 working-age adults with prediabetes insured for 3 continuous years between 2010 and 2012.
Percentage of health plan enrollees with prediabetes who were prescribed metformin.
Only 3.7% of patients with prediabetes were prescribed metformin over the 3-year study window. After adjustment for age, income, and education, the predicted probability of metformin prescription was almost 2 times higher among women and obese patients and more than 1.5 times higher among patients with 2 or more comorbid conditions.
Missing data on lifestyle interventions, possible misclassification of prediabetes and metformin use, and inability to define eligible patients exactly as defined in the American Diabetes Association guidelines.
Evidence shows that metformin is rarely prescribed for diabetes prevention in working-age adults. Future studies are needed to understand potential barriers to wider adoption of this safe, tolerable, evidence-based, and cost-effective prediabetes therapy.
Primary Funding Source:
Centers for Disease Control and Prevention (Division of Diabetes Translation) and the National Institute of Diabetes and Digestive and Kidney Diseases.
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Author, Article and Disclosure Information
From Veterans Affairs Greater Los Angeles Health System; Veterans Affairs Health Services Research and Development Service; and University of California, Los Angeles, Los Angeles, California, and UnitedHealthcare, Minneapolis, Minnesota.
Disclaimer: The findings and conclusions in this manuscript are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention (CDC) or the National Institutes of Health (NIH). Drs. Moin and Mangione had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.
Acknowledgment: The authors thank Mr. Robert Luchs and Mr. Charlie Chan for their help with obtaining the data used in this analysis, Ms. Lindsay Kimbro for her administrative and project management support, and all NEXT-D (Natural Experiments for the Translation of Diabetes) collaborators for their support.
Grant Support: This study was jointly funded by the CDC (Division of Diabetes Translation) and the National Institute of Diabetes and Digestive and Kidney Diseases as part of the NEXT-D study (grant U58DP002722-05). Dr. Moin received support from the Veterans Affairs (VA) Office of Academic Affiliations through the VA Health Services Research and Development Advanced Fellowship Program (TPM65-010) of the VA Greater Los Angeles Health System from 2011 to 2014. Dr. Mangione received support from the University of California, Los Angeles (UCLA)/Drew Center for Health Improvement of Minority Elderly (under NIH/National Institute on Aging grant P30-AG021684) and the NIH/National Center for Advancing Translational Sciences and UCLA Clinical and Translational Science Institute (grant UL1TR000124). Dr. Mangione holds the Barbara A. Levey and Gerald S. Levey Endowed Chair in Medicine, which partially supported her work. Dr. Duru is supported in part by the UCLA/Drew Center for Health Improvement of Minority Elderly (under NIH/National Institute on Aging grant P30-AG021684) and an NIH career development award (K08-AG033360).
Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M14-1773.
Reproducible Research Statement:Study protocol: A version with redacted confidential information is available to approved persons through written agreement with the authors (e-mail, [email protected]
Corresponding Author: Tannaz Moin, MD, MBA, MSHS, David Geffen School of Medicine at University of California, Los Angeles, Division of General Internal Medicine and Health Services Research, 911 Broxton Avenue, Los Angeles, CA 90024; e-mail, [email protected]
Current Author Addresses: Dr. Moin: David Geffen School of Medicine at University of California, Los Angeles, Division of General Internal Medicine and Health Services Research, 911 Broxton Avenue, Los Angeles, CA 90024.
Drs. Duru and Mangione, Ms. Li, and Mr. Turk: David Geffen School of Medicine at University of California, Los Angeles, 10940 Wilshire Boulevard, Suite 700, Los Angeles, CA 90095.
Dr. Ettner: David Geffen School of Medicine at University of California, Los Angeles, Division of General Internal Medicine and Health Services Research, 911 Broxton Plaza, Room 106, Box 951736, Los Angeles, CA 90095.
Ms. Keckhafer: UnitedHealthcare, PO Box 1459, Minneapolis, MN 55440.
Dr. Ho: UnitedHealthcare, 5995 Plaza Drive, Cypress, CA 90630.
Author Contributions: Conception and design: T. Moin, S. Ettner, S. Ho, C.M. Mangione.
Analysis and interpretation of the data: T. Moin, J. Li, O.K. Duru, S. Ettner, N. Turk, A. Keckhafer, S. Ho, C.M. Mangione.
Drafting of the article: T. Moin.
Critical revision of the article for important intellectual content: T. Moin, J. Li, O.K. Duru, S. Ettner, A. Keckhafer, S. Ho, C.M. Mangione.
Final approval of the article: T. Moin, O.K. Duru, S. Ettner, A. Keckhafer, C.M. Mangione.
Provision of study materials or patients: T. Moin, A. Keckhafer, S. Ho.
Statistical expertise: S. Ettner, N. Turk.
Obtaining of funding: O.K. Duru, S. Ettner, C.M. Mangione.
Administrative, technical, or logistic support: S. Ho, C.M. Mangione.
Collection and assembly of data: J. Li, N. Turk, A. Keckhafer, S. Ho.