Preventive Metformin Monotherapy Medication Prescription, Redemption and Socioeconomic Status in Hungary in 2018-2019: A Cross-Sectional Study.

Csilla Nagy,Attila Juhász,Péter Pikó,Róza Ádány,Zoltán Szabó,Judit Diószegi,György Paragh,Orsolya Varga

doi:10.3390/ijerph18052206

Abstract

This study was designed to characterize the spatial distribution of metformin medication used as first-line monotherapy for prevention of T2DM in relationship with the socioeconomic status (level of deprivation) and T2DM mortality at district level in a nationwide cross-sectional ecological study for the first time in a European country, Hungary. Risk analysis was used to estimate the relationships between socioeconomic status, characterized by tertiles of deprivation index, and mortality caused by diabetes, and metformin medication (both prescription and redemption) for the years of 2018 and 2019 at the district level. The spatial distribution of districts with a higher relative frequency of metformin prescriptions and redemptions showed a positive correlation with socio-economic deprivation. Significant association between the relatively high T2DM mortality and the highest level of deprivation could also be detected, but less-deprived regions with high T2DM mortality and low metformin utilization could also be identified. Although the statistical associations detected in this ecological study do not indicate a causal relationship, it is reasonable to suppose that the underuse of metformin medication may contribute to the unfavourable T2DM mortality in certain regions. Our findings underline the need for more effective preventive services including metformin medication to decrease T2DM morbidity and mortality burden.

Highlights

As the International Diabetes Federation (IDF) reports the number of people having type 2 diabetes mellitus (T2DM) more than tripled over the past 20 years; presently about463 million adults are diagnosed with T2DM worldwide and 11.4% of all cause deaths are due to diabetes [1]
In addition to T2DM diagnosed in health care services the IDF estimates that in 2019 about 373.9 million individuals (7.5% in the adult population) was affected by prediabetes, a pathological condition characterized by impaired fasting glucose and/or impaired glucose tolerance, which indicates severely increased risk or early phase of the development of diabetes [2,3]
In our previous studies we have demonstrated that while early death caused by cardiovascular diseases is in a strong positive correlation with socio-economic deprivation, preventive medication shows the opposite relationship for statin therapy against hypercholesterolaemia [19], for treatment with the new generation of antihypertensive medicines [20], as well as for antithrombotic preventive medication [21]

Summary

Introduction

As the International Diabetes Federation (IDF) reports the number of people having type 2 diabetes mellitus (T2DM) more than tripled over the past 20 years; presently about. 463 million adults are diagnosed with T2DM worldwide and 11.4% of all cause deaths are due to diabetes [1]. In addition to T2DM diagnosed in health care services the IDF estimates that in 2019 about 373.9 million individuals (7.5% in the adult population) was affected by prediabetes, a pathological condition characterized by impaired fasting glucose and/or impaired glucose tolerance, which indicates severely increased risk or early phase of the development of diabetes [2,3]. The rising incidence of T2DM across the world [1] increases the importance of evidence for effective ways to prevent it.

Methods

Results

Conclusion