• Alejandro Hughes, Tamkeen Khan, Kate Kirley, Tannaz Moin, Arch Mainous, Neha Sachdev, Janet Williams, and Gregory Wozniak.
• From American Medical Association, Chicago, IL (AH, TK, KK, NS, JW, GW); David Geffen School of Medicine at University of California, Los Angeles, CA (TM); HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA (TM); and University of Florida, Gainesville, FL (AM). Alejandro.Hughes@ama-assn.org.
• J Am Board Fam Med. 2022 Jul 1; 35 (4): 821826821-826.

PurposePrediabetes is a serious public health concern, with 34.5% of US adults meeting the criteria for prediabetes. The American Diabetes Association has highlighted metformin therapy as a consideration for individuals with BMI ≥ 35 kg/m2, those aged < 60 years, and women with a history of gestational diabetes. We examined metformin prescription rates among a national sample of commercially insured, higher risk patients with prediabetes.MethodsWe gathered 2012 to 2018 demographic, laboratory, and prescription data for 53,551 patients with prediabetes from the IBM MarketScan research database. Our primary outcome was metformin prescription rates 1 or 3 years after a laboratory confirmation of prediabetes among patients who have a BMI ≥ 35 kg/m2 or are aged < 60 years.ResultsOverall, 2.4% (n = 1,124) of patients received a metformin prescription within 1 year of a laboratory confirmed prediabetes result, including 2.4% of patients aged < 60 years and 10.4% of those with BMI ≥ 35 kg/m2. By a 3 year follow-up, 4.1% (n = 1901) received a metformin prescription, including 3.9% of patients aged < 60 years and 14.0% with BMI ≥ 35 kg/m2. Patients who developed type 2 diabetes within the 1 (n = 2,769) or 3 year (n = 7,268) follow-up periods were excluded from analysis.ConclusionsFew prediabetes patients who were either obese or aged < 60 years received a metformin prescription between 2012 and 2018. Prescription rates increased slightly between 1 and 3 years after a prediabetes diagnosis, so strategies to support timely intervention among higher risk patients with prediabetes are critically needed.© Copyright 2022 by the American Board of Family Medicine.

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