Metformin Still Underused in Patients with Type 2 Diabetes

All evidence points to metformin as the first-line oral diabetes treatment for patients with type 2 diabetes (T2D), but research indicates that clinicians often fail to prescribe it when indicated.

In a recent study published in Pharmacotherapy, a team of pharmacy researchers from Ohio looked at metformin, its use, and the reasons clinicians fail to initiate it. They used data from the National Ambulatory Medical Care Survey and conducted a national cross-sectional study of adults with T2D, although patients with chronic renal failure or heart failure were excluded because metformin is usually avoided in these patients.

Previous studies that looked at metformin use reported rates of 51% to 57.8% in fully insured patients with diabetes. In this study, which looked at overall metformin use, prescribers continued or initiated metformin at roughly 41% of visits—a rate the researchers indicated was unacceptably low. Other studies have found baseline prescribing rates closer to 60%.

Patients who were least likely to receive metformin were those who used insulin, had 4 or more chronic conditions, were Medicare beneficiaries, or saw a medical or surgical specialist. Meanwhile, patients who identified as Hispanic were most likely to receive metformin. As the number of diabetic complications increased, the likelihood that the patient received metformin decreased.

The study authors noted that insulin therapy should not preclude metformin use. When prescribed early, metformin has proved to decrease the need for insulin and may ameliorate some of insulin’s adverse effects.