American Diabetes Association
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Association of Unmet Social Needs with Metformin Use Among Patients with Type 2 Diabetes

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posted on 2023-09-26, 19:28 authored by Connor Drake, Jorge Morales Alfaro, Dan V. Blalock, Kristin Ito, Bryan C. Batch, Hayden B. Bosworth, Seth A. Berkowitz, Leah L. Zullig

Objective: To evaluate the relationship between social needs and metformin use among adults with type 2 diabetes (T2D).

Research Design and Methods: In a prospective cohort study of adults with T2D (n=722) we linked electronic health record (EHR) and Surescripts (Surescripts, LLC) prescription network data to abstract data on patient reported social needs and to calculate metformin adherence based on expected refill frequency using a proportion of days covered methodology.

Results: Adjusting for demographics and clinical complexity, 2 or more social needs (-0.046, 95%CI=-0.089,-0.003), being uninsured (-0.052, 95%CI=-0.095,-0.009) and while adjusting for other needs, being without housing (-0.069 95% CI=-0.121, -0.018), and lack of access to medicine/health care (-0.058 95% CI=-0.115, -0.000) were associated with lower use.

Conclusions: We found that overall social need burden and specific needs, particularly housing and healthcare access were associated with clinically significant reductions in metformin adherence among T2D patients.


This study was supported by the Blue Cross and Blue Shield Foundation of North Carolina. This study was also supported in part by the National Heart, Lung, And Blood Institute of the National Institutes of Health under Award Number K12HL138030 (CD, LZ, & HB). The study was also supported in part by Career Development Award 19–035 (IK2HX003085-01A2) from the United States Department of Veterans Affairs Health Services Research and Development (HSR&D) Service (DB). We thank the Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT) at the Durham Veterans Affairs Health Care System for their support. The content is solely the responsibility of the authors and does not necessarily reflect the position or policy of Duke University, the U.S. Department of Veterans Affairs, or the U.S. government.


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