Evaluation of the metformin initiation rate in veterans with newly identified type 2 diabetes

Published:February 15, 2021DOI:https://doi.org/10.1016/j.pcd.2021.01.014


      • 144,180 veterans, median age: 62 years. 88.2% with index A1C in range of 6.5-7.4%.
      • 45,776 on metformin at one year. Median time to metformin initiation was 12 days.
      • 49,269 on any anti-hyperglycemic at one year. Median time to initiation was 11 days.
      • 16,495 non-pharmacologic consults at 90 days.



      An estimated 35 million individuals in the United States have diabetes. The American Diabetes Association recommends metformin as first-line pharmacologic treatment. The primary objective of this study was to evaluate the metformin initiation rate in veterans with recently identified type 2 diabetes.


      Veterans with new onset type 2 diabetes were identified using National Veterans Health Administration Data. Retrospective information was obtained from those with a first A1C ≥ 6.5% (48 mmol/mol) between 2013 and 2018. Veterans with at least one additional A1C < 6.5% (48 mmol/mol) documented in the three years prior to the A1C diagnostic for diabetes were included in the analysis.


      A total of 144,180 veterans were included. Of those, 45,776 (31.7%) were started on metformin within one year of diabetes diagnosis. The median time to metformin initiation was 12 days and median time to initiation of any anti-hyperglycemic was 11 days. Approximately 16,000 veterans were referred for lifestyle interventions within 90 days.


      Metformin initiation occurred in fewer patients than expected given metformin is a generic, well-tolerated medication recommended as first-line pharmacologic treatment option regardless of A1C. Further studies are needed to assess the barriers of initiating metformin at time of diabetes diagnosis.


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