July 3, 2015

Doctors Ignore Guidelines for Prediabetes Patients

Many of the diabetes news sources are carrying this news item. The titles vary by what each source wants to emphasize. Basically, the consensus is disparaging about doctors that are under using metformin to treat prediabetes. Considering that the drug is generic and cheap, I can agree that this is an inexpensive therapy to help manage and possibly prevent the full onset of type 2 diabetes.

Before I continue, I will make some observations. First, I am not surprised at the lack of prescriptions for metformin because many doctors are not screening for prediabetes. Second, many doctors believe prediabetes and diabetes are a lifestyle disease and want patients to suffer and will not prescribe any medications until full diabetes is present and sometimes even then will delay medications. These doctors want to see improvement in weight and other lifestyle changes that prove the patient will follow a medication regimen. Many patients often surprise these doctors by making the lifestyle changes and not needing the medications the doctors were planning to make them take because the doctors believe that prediabetes and diabetes are progressive and people will not be able to manage their prediabetes or diabetes.

Metformin was prescribed for only 3.7% of patients with prediabetes, even though it can help prevent the onset of type 2 diabetes, according to a new retrospective cohort analysis. Lead author Tannaz Moin, MD, from the David Geffen School of Medicine at University of California, Los Angeles, says, “We were surprised to see just how low the [prescription] rates were, particularly among the highest-risk individuals, where evidence for metformin use is strongest."

"Despite inclusion in national guidelines for more than 6 years and proven long-term tolerability, safety, and cost-effectiveness, the prescription of metformin in the real-world clinical approach to diabetes prevention remains unclear," Dr Moin and colleagues write.

Their findings are published in the April 21 issue of the Annals of Internal Medicine.

Among those with a BMI equal to or greater than 35 kg/m2 (n= 391) or gestational diabetes (n = 121) the prevalence of metformin prescription was 7.8%. This is "the group for which the ADA guideline places the most emphasis on treating prediabetes with metformin," the authors write.

In their study, Dr Moin and colleagues analyzed data from a national sample of 17,352 adults aged 19 to 58 years with prediabetes between 2010 and 2012 who were insured for 3 continuous years to determine the percentage who were prescribed metformin.

In 2008, the American Diabetes Association (ADA) updated its "Standards for Medical Care in Diabetes" guidelines to include metformin use in patients aged less than 60 years who are at very high risk [of diabetes], are very obese (body mass index [BMI] greater than 35 kg/m2), or have a history of gestational diabetes.

The guidelines also say clinicians can consider metformin in those with impaired glucose tolerance, impaired fasting glucose, or an HbA1c of 5.7% to 6.4%.

Again, this study is interesting and would be more valuable if doctors were taking prediabetes seriously and screening for it.

Two other articles can be read. The first is from Science Daily, titled “Drug that can prevent onset of diabetes is rarely used.” The second is from Diabetes-in-Control and is titled “Metformin Reported in Use with Only 3.7% of Those with Prediabetes.”

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