Differing effects of metformin on glycemic control by race-ethnicity

Abstract

Context: Metformin is considered first-line treatment for type 2 diabetes mellitus. However, little is known about its effects in African American individuals.

Objective: The objective of the study was to assess whether metformin's effect on glycemic control differs by race-ethnicity Design: Electronic health records were used to identify adults who had a diagnosis of diabetes, two or more fills of metformin, and two or more glycated hemoglobin (HbA1c) measurements. Pharmacy claims were used to estimate metformin exposure based on fill frequency and dose dispensed. Regression analyses modeled the relationship between metformin exposure and HbA1c levels. Analyses were stratified by race-ethnicity and baseline HbA1c values.

Setting: The study was conducted at a large health system in southeast Michigan.

Main outcome measure: Differences in HbA1c levels while on metformin were measured.

Results: We identified 19 672 patients with diabetes taking metformin; 7429 were African American and 8783 were European American. Baseline HbA1c values in these two groups were 7.81% (61.8 mmol/mol) and 7.38% (57.1 mmol/mol), respectively. Compared with no use, metformin was associated with a 0.62% (6.8 mmol/mol) reduction in HbA1c; however, there was a significant difference by race-ethnicity (P < .001). Among African American individuals, metformin use was associated with a 0.90% (9.8 mmol/mol) reduction in HbA1c levels, whereas among European Americans, metformin was associated with a 0.42% (4.6 mmol/mol) reduction. Irrespective of baseline HbA1c, metformin use was associated with lower HbA1c levels in African American individuals.

Conclusions: African American individuals appear to have a better glycemic response to metformin when compared with European Americans. Further studies are needed to determine whether this translates to commensurate reductions in diabetes complications.

Figure 1.

The estimated effect of metformin treatment on HbA1c levels stratified by race-ethnicity and baseline HbA1c levels. Larger negative values suggest a greater effect of metformin in reducing long-term glycemia. Differences in the estimated effect of metformin between African American and European American individuals that reach statistical significance are denoted with the corresponding P value. Also presented is the number of individuals contributing data to each category along with the total number of observations for those individuals shown in parentheses. Analyses accounted for repeated measures within individuals.