Oregon Health & Science University Department of Family Medicine, Portland, OR, USA.
Oregon Health & Science University Department of Family Medicine, Portland, OR, USA.
Prev Med. 2024 Aug;185:108025. doi: 10.1016/j.ypmed.2024.108025. Epub 2024 Jun 2.
Metformin treatment is a recommended first-line medication for patients with type 2 diabetes. Latino patients are subject to factors that may modify their level of diabetes care, including medication prescription. We evaluated the odds of and times to metformin prescription among non-Latino whites, English-preferring Latinos, and Spanish-preferring Latinos with diabetes.
We constructed a retrospective cohort of 154,368 adult patients from 835 community health centers (CHCs) across 20 states who were diagnosed with diabetes during the study. Patients were from non-Latino white, English-preferring Latino, and Spanish-preferring Latino ethnic/language groups. We modeled adjusted odds of metformin prescription and adjusted hazards (time-to-event) of metformin prescription after diabetes diagnosis and high hemoglobin A1c (HbA1c > 9) test results.
English-preferring Latinos had similar odds of metformin prescription (Odds Ratio (OR) = 1.01 (95% CI = 0.93, 1.09)), slightly lower time to metformin prescription after diabetes diagnosis (Hazard Ratio (HR) = 1.06(95% CI = 1.04, 1.09)), and similar time to metformin prescription after a high HbA1c result (HR = 1.04 (0.99, 1.09)) compared to non-Latino whites. Spanish-preferring Latinos had higher odds of metformin prescription (OR) = 1.42 (95% CI = 1.33, 1.52), and less time to prescription after diabetes diagnosis (HR = 1.18 (1.15, 1.20)) and after a high HbA1c result (HR = 1.15 (1.11, 1.20)).
Our analysis of metformin prescription patterns among non-Latino whites, English-preferring Latinos, and Spanish-preferring Latinos did not suggest a lower or slower tendency to prescribe metformin in Latino patients. Understanding disparities in diabetes diagnosis may require further investigation of medication adherence barriers, diet and exercise counseling, and multi-level influences on diabetes outcomes in Latino patients.
二甲双胍治疗是推荐的 2 型糖尿病患者的一线药物。拉丁裔患者受到可能改变其糖尿病护理水平的因素的影响，包括药物处方。我们评估了非拉丁裔白人、英语偏好拉丁裔和西班牙语偏好拉丁裔糖尿病患者使用二甲双胍的几率和时间。
我们从 20 个州的 835 个社区医疗中心构建了一个回顾性队列，其中包括 154368 名成年糖尿病患者。患者来自非拉丁裔白人、英语偏好拉丁裔和西班牙语偏好拉丁裔族裔/语言群体。我们对糖尿病诊断后和高血红蛋白 A1c（HbA1c>9）检测结果后二甲双胍处方的调整几率和二甲双胍处方的调整风险（时间到事件）进行建模。
英语偏好的拉丁裔患者使用二甲双胍的几率相似（优势比（OR）=1.01（95%置信区间（CI）=0.93,1.09）），糖尿病诊断后使用二甲双胍的时间稍短（风险比（HR）=1.06（95%CI=1.04,1.09）），高 HbA1c 结果后使用二甲双胍的时间相似（HR=1.04（0.99,1.09））与非拉丁裔白人相比。西班牙语偏好的拉丁裔患者使用二甲双胍的几率更高（OR）=1.42（95%置信区间（CI）=1.33,1.52）），糖尿病诊断后处方时间更短（HR=1.18（1.15,1.20））和高 HbA1c 结果后处方时间更短（HR=1.15（1.11,1.20））。
我们对非拉丁裔白人、英语偏好拉丁裔和西班牙语偏好拉丁裔患者使用二甲双胍的模式进行了分析，结果并未表明拉丁裔患者开二甲双胍的几率或速度较低。要了解糖尿病诊断方面的差异，可能需要进一步调查药物依从性障碍、饮食和运动咨询以及对拉丁裔患者糖尿病结果的多层次影响。
