Division of Metabolism, Endocrinology, and Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, MI.
Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, Ann Arbor, MI.
Diabetes Care. 2022 Oct 1;45(10):2282-2288. doi: 10.2337/dc21-2316.
To use the framework of the Health Belief Model (HBM) to explore factors associated with metformin use among adults with prediabetes.
We analyzed survey data from 200 metformin users and 1,277 nonmetformin users with prediabetes identified from a large, insured workforce. All subjects were offered the National Diabetes Prevention Program (DPP) at no out-of-pocket cost. We constructed bivariate and multivariate models to investigate how perceived threat, perceived benefits, self-efficacy, and cues to action impacted metformin use and how demographic, clinical, sociopsychological, and structural variables impacted the associations.
Adults with prediabetes who used metformin were younger and more likely to be women and to have worse self-rated health and higher BMIs than those with prediabetes who did not use metformin. Those who used metformin were also more likely to be aware of their prediabetes and to have a personal history of gestational diabetes mellitus or a family history of diabetes. After consideration of perceived threat, perceived benefits, self-efficacy, and cues to action, the only independent predictors of metformin use were younger age, female sex, higher BMI, and cues to action, most specifically, a doctor offering metformin therapy.
Demographic and clinical factors and cues to action impact the likelihood of metformin use for diabetes prevention. Perceived threat, perceived benefits, and self-efficacy were not independently associated with metformin use. These results highlight the importance of patient-centered primary care and shared decision-making in diabetes prevention. Clinicians should proactively offer metformin to patients with prediabetes to facilitate effective diabetes prevention.
利用健康信念模型（HBM）的框架探讨与成年人糖尿病前期患者使用二甲双胍相关的因素。
我们分析了来自一个大型参保劳动力中 200 名二甲双胍使用者和 1277 名非二甲双胍使用者的糖尿病前期调查数据。所有患者都可以免费获得国家糖尿病预防计划（DPP）。我们构建了双变量和多变量模型，以研究感知威胁、感知益处、自我效能和行动线索如何影响二甲双胍的使用，以及人口统计学、临床、社会心理和结构变量如何影响这些关联。
与未使用二甲双胍的糖尿病前期患者相比，使用二甲双胍的糖尿病前期成年人更年轻，更可能是女性，自我报告的健康状况更差，BMI 更高。使用二甲双胍的患者也更有可能意识到自己患有糖尿病前期，并且有个人的妊娠糖尿病史或家族糖尿病史。在考虑感知威胁、感知益处、自我效能和行动线索后，二甲双胍使用的唯一独立预测因素是年龄较小、女性、BMI 较高和行动线索，特别是医生提供二甲双胍治疗。
人口统计学和临床因素以及行动线索会影响糖尿病预防中使用二甲双胍的可能性。感知威胁、感知益处和自我效能与二甲双胍的使用没有独立关联。这些结果强调了以患者为中心的初级保健和共同决策在糖尿病预防中的重要性。临床医生应主动向糖尿病前期患者提供二甲双胍，以促进有效的糖尿病预防。
