Why Isn’t Metformin Prescribed More?

Since its debut in the United States in 1995, metformin has become the most popular oral drug for Type 2 diabetes in the country — and the rest of the world. Current guidelines by the American Diabetes Association state that unless there are special risks in a particular person, metformin should be the first drug prescribed to people with Type 2 diabetes. Yet perhaps due in part to its popularity, metformin isn’t free of controversy. As we’ve discussed previously here at Diabetes Flashpoints, there are concerns about prescribing metformin in people with kidney disease, and some doctors even question whether metformin deserves its status as the universally recommended first-line drug for Type 2 diabetes. In addition, there’s debate about whether metformin should be taken by more people with prediabetes.

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A recent study sought to explore the reasons why metformin isn’t prescribed as widely as clinical guidelines suggest it should be. Published last month in the journal Therapeutic Advances in Chronic Disease, the study notes that only roughly 65% of people with newly diagnosed Type 2 diabetes are prescribed metformin — and that over time, this number drops to just 25% of people with the condition. As noted in a Pharmacy Times article on the study, researchers from the University of Colorado put together focus groups of relevant people — doctors, pharmacists, and other medical personnel — to ask about their perceptions regarding metformin.

Based on these focus groups, the researchers found that three main factors affected how doctors prescribed metformin: concerns about when to start the drug, concerns about the drug’s known risks, and whether procedures were in place to notice and deal with any adverse reactions caused by the drug.

Based on the focus groups’ responses, the researchers concluded that overall, perceptions about the risks of metformin weren’t based on the latest research and clinical recommendations — especially when it came to the risk of lactic acidosis (a very rare but serious side effect of metformin and certain other drugs), as well as how compatible the drug is with kidney disease, heart failure, liver disease, or alcohol use. When the latest evidence was discussed with members of the focus groups, some participants shared that their attitude toward prescribing metformin had changed. This led the researchers to conclude that certain education efforts — including distributing information, but also incorporating guidelines into tools for electronic prescribing — could lead more doctors to prescribe metformin to more patients, in accordance with clinical guidelines.

What’s your experience with metformin — do you take it, or have you taken it in the past? Is it the first drug that your doctor prescribed for your diabetes? If you no longer take it, why? Did you experience any unpleasant reactions or side effects from the drug? Do you think it’s important for doctors to follow clinical guidelines for prescribing drugs, or should they let their own experience be their guide? Leave a comment below!

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