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.”
