Metformin prescribing in Medicaid population with prediabetes remains low

JAPhA study: Fewer than 8% receive recommended prescriptions

The landmark Diabetes Prevention Program showed that treatment with metformin can cut the risk of developing diabetes by 31% in people who have prediabetes, leading the American Diabetes Association to recommend metformin for patients in this population. Yet fewer than 8% of low-income patients with prediabetes who are covered by Medicaid receive prescriptions for metformin, according to a study published in the July-August 2017 issue of the Journal of the American Pharmacists Association.

Using South Carolina Medicaid claims data, researchers identified and followed 7,102 patients with prediabetes from 2009 to 2014. Of those patients, only 7.4% were prescribed metformin. Patients who had received metformin prescriptions were older than those who did not, with an average age of 40.2 years compared with 37.6 years, and their odds of receiving a prescription increased 10% with every 5-year increase in age. They also had been enrolled in Medicaid roughly 3 months longer than those who did not receive prescriptions. An analysis of patient demographics showed that patients who were enrolled in managed care plans (versus fee-for-service plans), were African American, or had comorbid conditions like hypertension, obesity, or dyslipidemia were more likely to receive prescriptions for metformin.

The authors note that their results may suggest an upward trend in metformin prescribing, as a separate study of privately insured patients between 2010 and 2012 showed that only 3.5% of those with prediabetes received metformin prescriptions, up from 0.1% in a study of patients between 2006 and 2010. Yet the authors conclude that metformin is underused in treating prediabetes, indicating a gap in care between clinical guidelines and real-world practice.