Murphy Pilar Z, Bramwell-Shittu Alanna, Boehmer Kaci, Painter Jacob, Mahashabde Ruchira
University of Arkansas for Medical Sciences College of Pharmacy and College of Medicine.
University of Arkansas for Medical Sciences College of Pharmacy.
Innov Pharm. 2024 Aug 21;15(3). doi: 10.24926/iip.v15i3.5779. eCollection 2024.
The aim of the present study is to determine similarities between patients with type 2 diabetes not on metformin therapy compared to patients on metformin therapy at a resident-led primary care clinic. An exploratory, single-center retrospective chart review was performed on patients 18 years and older with a documented diagnosis of type 2 diabetes seen at the University of Arkansas for Medical Sciences Family Medicine Clinic in Little Rock, Arkansas. Of the 2452 patients who met criteria for the study, 1085 patients did not have a documented metformin allergy. A subset of 216 patients who were not currently prescribed metformin and had no documented metformin allergy were further examined and compared to the 869 patients who were prescribed metformin. We sought to determine reasons for nonuse by evaluating their EPIC electronic health record. Information on these patients such as race, gender, hemoglobin A1c (A1c), kidney function, stated metformin intolerance, and comorbid disease states such as neuropathy, chronic kidney disease (CKD), ulcerative colitis, and irritable bowel syndrome were collected. Further examination was performed to determine why patients were not on metformin therapy and potential similarities between metformin intolerant patients. The results of the study indicated a significant difference between metformin users and non-users in relation to body mass index (BMI) and diagnosis of CKD. Metformin non-users were found to have significantly lower mean BMI (30.87 vs. 35.43; p-value <0.0001), and significantly higher rates of CKD (25.93% vs 14.73%; p-value <0.0001) as compared to metformin users. BMI value of patients (coefficient: 0.2033, p value: <0.0001) was found to be significantly and positively correlated with metformin use, and CKD (coefficient: - 0.1191, p-value: <0.0001) was found to be significantly and negatively correlated with metformin use. A1c levels for patients not on metformin therapy were evaluated. Most non-metformin patients fell in prediabetic A1c levels ranging from 5-6.4% (84 patients; 38.89%), and 31 patients (14.35%) should be on insulin therapy according to guidelines. The results demonstrated that patients with lower BMI, CKD, or A1c in the prediabetic range were less likely to be prescribed metformin.
本研究的目的是确定在一家由住院医师主导的初级保健诊所中，未接受二甲双胍治疗的2型糖尿病患者与接受二甲双胍治疗的患者之间的相似性。对阿肯色大学医学科学家庭医学诊所（位于阿肯色州小石城）中18岁及以上且有2型糖尿病确诊记录的患者进行了一项探索性的单中心回顾性病历审查。在符合研究标准的2452名患者中，1085名患者没有二甲双胍过敏的记录。对216名目前未开具二甲双胍且无二甲双胍过敏记录的患者进行了进一步检查，并与869名开具了二甲双胍的患者进行比较。我们试图通过评估他们的EPIC电子健康记录来确定未使用二甲双胍的原因。收集了这些患者的种族、性别、糖化血红蛋白（A1c）、肾功能、所述的二甲双胍不耐受情况以及合并疾病状态，如神经病变、慢性肾脏病（CKD）、溃疡性结肠炎和肠易激综合征等信息。进行了进一步检查以确定患者未接受二甲双胍治疗的原因以及二甲双胍不耐受患者之间的潜在相似性。研究结果表明，二甲双胍使用者和非使用者在体重指数（BMI）和CKD诊断方面存在显著差异。与二甲双胍使用者相比，未使用二甲双胍的患者平均BMI显著更低（30.87对35.43；p值<0.0001），CKD发生率显著更高（25.93%对14.73%；p值<0.0001）。发现患者的BMI值（系数：0.2033，p值：<0.0001）与二甲双胍的使用显著正相关，而CKD（系数：-0.1191，p值：<0.0001）与二甲双胍的使用显著负相关。对未接受二甲双胍治疗的患者的A1c水平进行了评估。大多数未使用二甲双胍的患者处于糖尿病前期A1c水平范围5 - 6.4%（84名患者；38.89%），根据指南，31名患者（14.35%）应接受胰岛素治疗。结果表明，BMI较低、患有CKD或处于糖尿病前期范围的A1c水平的患者开具二甲双胍的可能性较小。
