Prescribing Attitudes, Behaviors and Opinions Regarding Metformin for Patients with Diabetes: a Focus Group Study

Overview

Journal Ther Adv Chronic Dis

Publisher Sage Publications

Date 2016 Sep 2

PMID 27583122

Citations 6

Authors

Katy E Trinkley

Daniel C Malone

Jennifer A Nelson

Joseph J Saseen

Affiliations

Soon will be listed here.

Abstract

Background: The purpose of this study was to identify the reasons why metformin prescribing is suboptimal.

Methods: Two semi-structured focus groups with attitudinal questionnaires and a brief educational presentation were held in two US cities. Participants included providers (physicians, pharmacists, midlevel practitioners) caring for patients with type 2 diabetes mellitus (T2DM) in an ambulatory setting. Outcome measures included provider attitudes, behaviors and opinions regarding the use of metformin.

Results: Participants identified three main themes influencing the use of metformin, including the appropriate timing of metformin initiation, known risks associated with metformin, and procedures to manage safety concerns and mitigate adverse effects associated with metformin. Participant prescribing behaviors of metformin were not consistent with the best available evidence in the settings of renal insufficiency, heart failure, hepatic dysfunction, alcohol use, and lactic acidosis. With minimal education, provider prescribing behaviors appeared to change by the end of the focus group to align more closely with the best available evidence.

Conclusions: Provider attitudes, behaviors and opinions regarding the use of metformin for T2DM reveals the need for further education to improve appropriate use of metformin. Educational interventions should target prescribing behaviors and opinions identified to be inconsistent with the evidence.

Citing Articles

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Flory J, Keating S, Guelce D, Mushlin A Patient Prefer Adherence. 2019; 13:1433-1441.

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References

Desai N, Shrank W, Fischer M, Avorn J, Liberman J, Schneeweiss S . Patterns of medication initiation in newly diagnosed diabetes mellitus: quality and cost implications. Am J Med. 2012; 125(3):302.e1-7. PMC: 4347833. DOI: 10.1016/j.amjmed.2011.07.033. View

Salpeter S, Greyber E, Pasternak G, Salpeter Posthumous E . Risk of fatal and nonfatal lactic acidosis with metformin use in type 2 diabetes mellitus. Cochrane Database Syst Rev. 2010; (1):CD002967. DOI: 10.1002/14651858.CD002967.pub3. View

Eurich D, Majumdar S, McAlister F, Tsuyuki R, Johnson J . Improved clinical outcomes associated with metformin in patients with diabetes and heart failure. Diabetes Care. 2005; 28(10):2345-51. DOI: 10.2337/diacare.28.10.2345. View

Bolen S, Feldman L, Vassy J, Wilson L, Yeh H, Marinopoulos S . Systematic review: comparative effectiveness and safety of oral medications for type 2 diabetes mellitus. Ann Intern Med. 2007; 147(6):386-99. DOI: 10.7326/0003-4819-147-6-200709180-00178. View

. Effect of intensive blood-glucose control with metformin on complications in overweight patients with type 2 diabetes (UKPDS 34). UK Prospective Diabetes Study (UKPDS) Group. Lancet. 1998; 352(9131):854-65. View

Eurich D, Weir D, Majumdar S, Tsuyuki R, Johnson J, Tjosvold L . Comparative safety and effectiveness of metformin in patients with diabetes mellitus and heart failure: systematic review of observational studies involving 34,000 patients. Circ Heart Fail. 2013; 6(3):395-402. DOI: 10.1161/CIRCHEARTFAILURE.112.000162. View

Ricci J, Coulen C, Berger J, Moore M, McQueen A, Jan S . Prescriber compliance with black box warnings in older adult patients. Am J Manag Care. 2009; 15(11):e103-8. View

Cohen F, Neslusan C, Conklin J, Song X . Recent antihyperglycemic prescribing trends for US privately insured patients with type 2 diabetes. Diabetes Care. 2003; 26(6):1847-51. DOI: 10.2337/diacare.26.6.1847. View

Cryer D, Nicholas S, Henry D, Mills D, Stadel B . Comparative outcomes study of metformin intervention versus conventional approach the COSMIC Approach Study. Diabetes Care. 2005; 28(3):539-43. DOI: 10.2337/diacare.28.3.539. View

10.

Kitzinger J . Qualitative research. Introducing focus groups. BMJ. 1995; 311(7000):299-302. PMC: 2550365. DOI: 10.1136/bmj.311.7000.299. View

11.

Emslie-Smith A, Boyle D, Evans J, Sullivan F, Morris A . Contraindications to metformin therapy in patients with Type 2 diabetes--a population-based study of adherence to prescribing guidelines. Diabet Med. 2001; 18(6):483-8. DOI: 10.1046/j.1464-5491.2001.00509.x. View

12.

Andersson C, Olesen J, Hansen P, Weeke P, Norgaard M, Jorgensen C . Metformin treatment is associated with a low risk of mortality in diabetic patients with heart failure: a retrospective nationwide cohort study. Diabetologia. 2010; 53(12):2546-53. DOI: 10.1007/s00125-010-1906-6. View

13.

Holstein A, NAHRWOLD D, Hinze S, Egberts E . Contra-indications to metformin therapy are largely disregarded. Diabet Med. 1999; 16(8):692-6. DOI: 10.1046/j.1464-5491.1999.00115.x. View

14.

Aguilar D, Chan W, Bozkurt B, Ramasubbu K, Deswal A . Metformin use and mortality in ambulatory patients with diabetes and heart failure. Circ Heart Fail. 2010; 4(1):53-8. PMC: 3046634. DOI: 10.1161/CIRCHEARTFAILURE.110.952556. View

15.

Goldberg T, Kroehl M, Suddarth K, Trinkley K . Variations in Metformin Prescribing for Type 2 Diabetes. J Am Board Fam Med. 2015; 28(6):777-84. DOI: 10.3122/jabfm.2015.06.150064. View

16.

MacDonald M, Eurich D, Majumdar S, Lewsey J, Bhagra S, Jhund P . Treatment of type 2 diabetes and outcomes in patients with heart failure: a nested case-control study from the U.K. General Practice Research Database. Diabetes Care. 2010; 33(6):1213-8. PMC: 2875425. DOI: 10.2337/dc09-2227. View