Association between ethnicity, language and metformin prescriptions in U.S. community health center patients with diabetes

• Published in: Preventive medicine Vol. 185; p. 108025
• Main Authors: Ezekiel-Herrera, David, Marino, Miguel, Lucas, Jennifer A., Datta, Roopradha, Aceves, Benjamín, Boston, Dave, Heintzman, John
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.08.2024
• Subjects: Adult; Aged; Community Health Centers; Diabetes; Diabetes Mellitus, Type 2 - drug therapy; Diabetes Mellitus, Type 2 - ethnology; Drug Prescriptions - statistics & numerical data; Ethnicity; Female; Glycated Hemoglobin - analysis; Health disparities; Hispanic or Latino; Humans; Hypoglycemic Agents - therapeutic use; Internal Medicine; Language; Male; Metformin; Metformin - therapeutic use; Middle Aged; Retrospective Studies; United States; White; United States; Diabetes; Metformin; Community health centers; Health disparities
• ISSN: 0091-7435; 1096-0260; 1096-0260
• DOI: 10.1016/j.ypmed.2024.108025

Metformin treatment is a recommended first-line medication for patients with type 2 diabetes. Latino patients are subject to factors that may modify their level of diabetes care, including medication prescription. We evaluated the odds of and times to metformin prescription among non-Latino whites, English-preferring Latinos, and Spanish-preferring Latinos with diabetes. We constructed a retrospective cohort of 154,368 adult patients from 835 community health centers (CHCs) across 20 states who were diagnosed with diabetes during the study. Patients were from non-Latino white, English-preferring Latino, and Spanish-preferring Latino ethnic/language groups. We modeled adjusted odds of metformin prescription and adjusted hazards (time-to-event) of metformin prescription after diabetes diagnosis and high hemoglobin A1c (HbA1c > 9) test results. English-preferring Latinos had similar odds of metformin prescription (Odds Ratio (OR) = 1.01 (95% CI = 0.93, 1.09)), slightly lower time to metformin prescription after diabetes diagnosis (Hazard Ratio (HR) = 1.06(95% CI = 1.04, 1.09)), and similar time to metformin prescription after a high HbA1c result (HR = 1.04 (0.99, 1.09)) compared to non-Latino whites. Spanish-preferring Latinos had higher odds of metformin prescription (OR) = 1.42 (95% CI = 1.33, 1.52), and less time to prescription after diabetes diagnosis (HR = 1.18 (1.15, 1.20)) and after a high HbA1c result (HR = 1.15 (1.11, 1.20)). Our analysis of metformin prescription patterns among non-Latino whites, English-preferring Latinos, and Spanish-preferring Latinos did not suggest a lower or slower tendency to prescribe metformin in Latino patients. Understanding disparities in diabetes diagnosis may require further investigation of medication adherence barriers, diet and exercise counseling, and multi-level influences on diabetes outcomes in Latino patients. •Metformin prescriptions at US health centers are similar between Latinos and whites.•Spanish-speaking Latinos are prescribed more than English-speaking Latinos.•Time to metformin prescription from diabetes diagnosis is not worse in Latinos