Tseng Eva, Yeh Hsin-Chieh, Maruthur Nisa M
Division of General Internal Medicine, Johns Hopkins University, Baltimore, MD
Division of General Internal Medicine, Johns Hopkins University, Baltimore, MD.
Diabetes Care. 2017 Jul;40(7):887-893. doi: 10.2337/dc16-1509. Epub 2017 Apr 3.
To determine the prevalence of and characteristics associated with metformin use among U.S. adults with prediabetes using the National Health and Nutrition Examination Survey (NHANES) 2005-2012.
The American Diabetes Association's guidelines for metformin use in prediabetes have evolved, with 2017 recommendations suggesting metformin be considered in patients with prediabetes and additional risk factors (BMI ≥35 kg/m, age <60 years, or prior gestational diabetes mellitus) or rising hemoglobin A (HbA). We estimated the age-adjusted prevalence of metformin use among individuals with prediabetes (defined by HbA 5.7-6.4%, fasting glucose 100-125 mg/dL, 2-h poststimulated glucose 140-199 mg/dL, or self-report) and used multivariate logistic regression to evaluate characteristics associated with metformin use.
Of 22,174 adults, 7,652 had prediabetes. The age-adjusted prevalence of metformin use among those with prediabetes was 0.7%. Metformin use was associated with higher mean BMI (35.1 kg/m vs. 29.6 kg/m, < 0.01) and higher glucose (fasting glucose 114 mg/dL vs. 105 mg/dL, = 0.03; 2-h poststimulated glucose 155 mg/dL vs. 128 mg/dL, = 0.003; and HbA 6.0% [42 mmol/mmol] vs. 5.6% [38 mmol/mmol], < 0.01). Metformin use was low even among those with BMI ≥35 kg/m, a group for whom metformin use is recommended. Metformin use did not vary by race, poverty-to-income ratio, or education.
Metformin use was <1% among U.S. adults with prediabetes and only slightly more common among those with additional risk factors for diabetes.
利用2005 - 2012年美国国家健康与营养检查调查（NHANES）确定美国糖尿病前期成年人中二甲双胍的使用患病率及相关特征。
美国糖尿病协会关于糖尿病前期使用二甲双胍的指南不断演变，2017年的建议表明，对于有糖尿病前期且存在其他风险因素（体重指数[BMI]≥35 kg/m²、年龄<60岁或既往有妊娠期糖尿病）或糖化血红蛋白（HbA₁c）升高的患者，可考虑使用二甲双胍。我们估计了糖尿病前期个体（根据HbA₁c 5.7 - 6.4%、空腹血糖100 - 125 mg/dL、刺激后2小时血糖140 - 199 mg/dL或自我报告定义）中二甲双胍使用的年龄调整患病率，并使用多因素逻辑回归评估与二甲双胍使用相关的特征。
在22174名成年人中，7652人患有糖尿病前期。糖尿病前期人群中二甲双胍使用的年龄调整患病率为0.7%。二甲双胍的使用与较高的平均BMI（35.1 kg/m²对29.6 kg/m²，P<0.01）和较高的血糖水平相关（空腹血糖114 mg/dL对105 mg/dL，P = 0.03；刺激后2小时血糖155 mg/dL对128 mg/dL，P = 0.003；HbA₁c 6.0%[42 mmol/mmol]对5.6%[38 mmol/mmol]，P<0.01）。即使在BMI≥35 kg/m²的人群中，二甲双胍的使用也很低，而该人群是推荐使用二甲双胍的。二甲双胍的使用在种族、贫困收入比或教育程度方面没有差异。
美国糖尿病前期成年人中二甲双胍的使用率<1%，在有其他糖尿病风险因素的人群中仅略为常见。
