From American Medical Association, Chicago, IL (AH, TK, KK, NS, JW, GW); David Geffen School of Medicine at University of California, Los Angeles, CA (TM); HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA (TM); and University of Florida, Gainesville, FL (AM).
J Am Board Fam Med. 2022 Jul-Aug;35(4):821-826. doi: 10.3122/jabfm.2022.04.210485.
Prediabetes is a serious public health concern, with 34.5% of US adults meeting the criteria for prediabetes. The American Diabetes Association has highlighted metformin therapy as a consideration for individuals with BMI 35 kg/m, those aged 60 years, and women with a history of gestational diabetes. We examined metformin prescription rates among a national sample of commercially insured, higher risk patients with prediabetes.
We gathered 2012 to 2018 demographic, laboratory, and prescription data for 53,551 patients with prediabetes from the IBM MarketScan research database. Our primary outcome was metformin prescription rates 1 or 3 years after a laboratory confirmation of prediabetes among patients who have a BMI 35 kg/m or are aged 60 years.
Overall, 2.4% (n = 1,124) of patients received a metformin prescription within 1 year of a laboratory confirmed prediabetes result, including 2.4% of patients aged 60 years and 10.4% of those with BMI 35 kg/m. By a 3 year follow-up, 4.1% (n = 1901) received a metformin prescription, including 3.9% of patients aged 60 years and 14.0% with BMI 35 kg/m. Patients who developed type 2 diabetes within the 1 (n = 2,769) or 3 year (n = 7,268) follow-up periods were excluded from analysis.
Few prediabetes patients who were either obese or aged 60 years received a metformin prescription between 2012 and 2018. Prescription rates increased slightly between 1 and 3 years after a prediabetes diagnosis, so strategies to support timely intervention among higher risk patients with prediabetes are critically needed.
糖尿病前期是一个严重的公共卫生问题，美国有 34.5%的成年人符合糖尿病前期标准。美国糖尿病协会强调，对于 BMI 大于等于 35kg/m²、年龄大于等于 60 岁的个体，以及有妊娠糖尿病史的女性，应考虑使用二甲双胍治疗。我们调查了在一个具有糖尿病前期的商业保险高风险患者的全国性样本中，二甲双胍的处方率。
我们从 IBM MarketScan 研究数据库中收集了 2012 年至 2018 年 53551 例糖尿病前期患者的人口统计学、实验室和处方数据。我们的主要结局是在实验室确认糖尿病前期后 1 年或 3 年内，BMI 大于等于 35kg/m²或年龄大于等于 60 岁的患者中，使用二甲双胍的处方率。
总体而言，在实验室确认糖尿病前期结果后的 1 年内，有 2.4%（n=1124）的患者接受了二甲双胍处方，其中 60 岁的患者占 2.4%，BMI 大于等于 35kg/m²的患者占 10.4%。在 3 年的随访中，有 4.1%（n=1901）的患者接受了二甲双胍处方，其中 60 岁的患者占 3.9%，BMI 大于等于 35kg/m²的患者占 14.0%。在 1 年（n=2769）或 3 年（n=7268）的随访期间发生 2 型糖尿病的患者被排除在分析之外。
在 2012 年至 2018 年期间，BMI 大于等于 35kg/m²或年龄大于等于 60 岁的糖尿病前期患者中，很少有患者接受二甲双胍处方。在糖尿病前期诊断后 1 至 3 年内，处方率略有增加，因此迫切需要制定策略来支持对糖尿病前期高风险患者的及时干预。
