The American Diabetes Association (ADA) recommends that treatment with metformin be considered for prevention of type 2 diabetes in persons with prediabetes. However, metformin use outside the setting of diagnosed diabetes in US adults is not well characterized.
To examine trends in self-reported prediabetes and treatment with metformin. We also compared characteristics of adults self-reported prediabetes who were vs. were not taking metformin.
Adults ≥ 20 years of age who participated in the 2005–2014 National Health and Nutrition and Examination Survey (NHANES), n = 28,461.
We characterized trends in self-reported prediabetes and metformin use in this population. We used multiple logistic regression models to identify predictors of metformin use among adults with self-reported prediabetes. All analyses accounted for the weighted complex survey design to generate nationally representative estimates.
The prevalence of self-reported prediabetes increased from 5.1% in 2005–2006 to 7.4% in 2013–2014 (P-for-trend < 0.001). In persons with self-reported prediabetes, metformin use increased, from 2.4 to 8.3% (P-for-trend = 0.013). Adults who were taking metformin were more likely to be obese and to report trying to lose weight in the past year.
Self-reported prediabetes has increased in the past decade. Metformin use in the setting of prediabetes has also increased but remains relatively uncommon at 8% in adults who self-report prediabetes, despite current clinical recommendations.
This is a preview of subscription content, log in to check access.
Buy single article
Instant unlimited access to the full article PDF.
Price includes VAT for USA
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
This is the net price. Taxes to be calculated in checkout.
Selvin E, Parrinello CM, Sacks DB, Coresh J. Trends in prevalence and control of diabetes in the United States, 1988-1994 and 1999-2010. Ann Intern Med. 2014;160(8):517–525.
Wang L, Gao P, Zhang M, et al. Prevalence and Ethnic Pattern of Diabetes and Prediabetes in China in 2013. JAMA. 2017;317(24):2515.
Ali MK, Bullard KM, Saydah S, Imperatore G, Gregg EW. Cardiovascular and renal burdens of prediabetes in the USA: analysis of data from serial cross-sectional surveys, 1988–2014. Lancet Diabetes Endocrinol. 2018;6(5):392–403.
Warren B, Matsushita K, Punjabi NM, et al. Comparative prognostic performance of definitions of prediabetes: a prospective cohort analysis of the Atherosclerosis Risk in Communities (ARIC) study. Lancet Diabetes Endocrinol. 2017;5(5):34–42.
Huang Y, Cai X, Mai W, Li M, Hu Y. Association between prediabetes and risk of cardiovascular disease and all cause mortality: systematic review and meta-analysis. BMJ. 2016;355:i5953.
James C, Bullard KM, Rolka DB, et al. Implications of Alternative Definitions of Prediabetes for Prevalence in U.S. Adults. Diabetes Care. 2011;34(2):387–391.
Tseng E, Yeh H-C, Maruthur NM. Metformin Use in Prediabetes Among U.S. Adults, 2005-2012. Diabetes Care. 2017;40(7):887–893.
American Diabetes Association. Standards of Medical Care in Diabetes—2008. Diabetes Care. 2008;31(Supplement 1):S12–S54.
Knowler WC, Barrett-Connor E, Fowler SE, Hamman RF, Lachin JM, Walker EA, Nathan DM. Reduction in the Incidence of Type 2 Diabetes With Lifestyle Intervention or Metformin. N Engl J Med. 2016;346(6):393–403.
Ramachandran A, Snehalatha C, Mary S, et al. The Indian Diabetes Prevention Programme shows that lifestyle modification and metformin prevent type 2 diabetes in Asian Indian subjects with impaired glucose tolerance (IDPP-1). Diabetologia. 2006;49(2):289–297.
Moin T, Li J, Duru OK, et al. Metformin Prescription for Insured Adults With Prediabetes From 2010 to 2012. Ann Intern Med. 2015;162(8):542.
Wu J, Ward E, Threatt T, Lu ZK. Metformin prescribing in low-income and insured patients with prediabetes. J Am Pharm Assoc. 2017;57(4):483–487.
National Center for Health Statistics. NHANES - Continuous NHANES Web Tutorial - Sample Design. Available at: https://www.cdc.gov/nchs/tutorials/Nhanes/SurveyDesign/SampleDesign/intro.htm. Accessed August 13, 2019.
National Center for Health Statistics. Continuous NHANES Web Tutorial: Specifying Sampling Parameters: Key Concepts about NHANES Survey Design. Available at: https://www.cdc.gov/nchs/tutorials/NHANES/SurveyDesign/SampleDesign/Info1.htm. Accessed August 13, 2019.
Centers for Disease Control and Prevention. NHANES 2005-2006: Diabetes Data Documentation, Codebook, and Frequencies. Available at: https://wwwn.cdc.gov/Nchs/Nhanes/2005-2006/DIQ_D.htm. Accessed August 13, 2019.
Centers for Disease Control and Prevention. NHANES 2005-2006: Prescription Medications Data Documentation, Codebook, and Frequencies. Available at: https://wwwn.cdc.gov/Nchs/Nhanes/2005-2006/RXQ_RX_D.htm. Accessed August 13, 2019.
Klein S, Allison DB, Heymsfield SB, et al. Waist circumference and cardiometabolic risk: a consensus statement from shaping America’s health: Association for Weight Management and Obesity Prevention; NAASO, the Obesity Society; the American Society for Nutrition; and the American Diabetes Associat. Diabetes Care. 2007;30(6):1647–1652.
Selvin E, Wang D, Lee AK, Bergenstal RM, Coresh J. Identifying Trends in Undiagnosed Diabetes in U.S. Adults by Using a Confirmatory Definition. Ann Intern Med. 2017;167(11):769–776.
Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults. J Am Coll Cardiol. 2018;71(19):e127–e248.
Goff DC, Lloyd-Jones DM, Bennett G, et al. 2013 ACC/AHA Guideline on the Assessment of Cardiovascular Risk: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014;129(25 Suppl 2):S49–73.
Centers for Disease Control and Prevention. NHANES 2007-2008: Physical Activity Data Documentation, Codebook, and Frequencies. Available at: https://wwwn.cdc.gov/Nchs/Nhanes/2007-2008/PAQ_E.htm. Accessed August 13, 2019
World Health Organization P of NDD. Global Physical Activity Questionnaire (GPAQ) Analysis Guide. Available at: www.who.int/chp/steps. Accessed August 13, 2019.
Centers for Disease Control and Prevention. Continuous NHANES Web Tutorial: STATA Tips. Available at: https://www.cdc.gov/nchs/tutorials/nhanes/stata_tips.htm. Accessed August 13, 2019.
Centers for Disease Control and Prevention. Continuous NHANES Web Tutorial: Variance Estimation: Variance Estimation in NHANES. Available at: https://www.cdc.gov/nchs/tutorials/NHANES/SurveyDesign/VarianceEstimation/Info2.htm. Accessed August 13, 2019.
Centers for Disease Control and Prevention. Continuous NHANES Web Tutorial: Age Standardization: Task 2c. Available at: https://www.cdc.gov/nchs/tutorials/NHANES/NHANESAnalyses/AgeStandardization/Task2c.htm. Accessed August 13, 2019.
American Diabetes Association. Screening for Diabetes. Diabetes Care. 1996;19(Supplement 1):S5–S7.
Centers for Disease Control and Prevention. Diabetes Prevention Recognition Program Standards and Operating Procedures. March 1, 2018. Available at: https://www.cdc.gov/diabetes/prevention/pdf/dprp-standards.pdf. Accessed August 13, 2019.
Flegal KM, Kruszon-Moran D, Carroll MD, Fryar CD, Ogden CL. Trends in Obesity Among Adults in the United States, 2005 to 2014. JAMA. 2016;315(21):2284.
Centers for Disease Control and Prevention. National Diabetes Statistics Report, 2017. Available at: https://www.cdc.gov/diabetes/pdfs/data/statistics/national-diabetes-statistics-report.pdf. Accessed August 13, 2019.
Menke A, Casagrande S, Geiss L, Cowie CC. Prevalence of and Trends in Diabetes Among Adults in the United States, 1988-2012. JAMA. 2015;314(10):1021.
Selvin E, Crainiceanu CM, Brancati FL, Coresh J. Short-term Variability in Measures of Glycemia and Implications for the Classification of Diabetes. Arch Intern Med. 2007;167(14):1545.
Selvin E, Coresh J, Brancati FL. The Burden and Treatment of Diabetes in Elderly Individuals in the U.S. Diabetes Care. 2006;29(11):2415–2419.
The authors would like to thank NHANES staff and participants.
Elizabeth Selvin was supported by NIH/NIDDK grant K24 DK106414. Kathryn Foti was supported by NIH/NHLBI grant T32 HL007024.
Conflict of Interest
The authors have no conflicts of interests to disclose.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Electronic supplementary material
About this article
Cite this article
Liu, C., Foti, K., Grams, M.E. et al. Trends in Self-reported Prediabetes and Metformin Use in the USA: NHANES 2005–2014. J GEN INTERN MED 35, 95–101 (2020) doi:10.1007/s11606-019-05398-5
- population health