OBJECTIVE To use the framework of the Health Belief Model (HBM) to explore factors associated with metformin use among adults with prediabetes. RESEARCH DESIGN AND METHODS We analyzed survey data from 200 metformin users and 1,277 nonmetformin users with prediabetes identified from a large, insured workforce. All subjects were offered the National Diabetes Prevention Program (DPP) at no out-of-pocket cost. We constructed bivariate and multivariate models to investigate how perceived threat, perceived benefits, self-efficacy, and cues to action impacted metformin use and how demographic, clinical, sociopsychological, and structural variables impacted the associations. RESULTS Adults with prediabetes who used metformin were younger and more likely to be women and to have worse self-rated health and higher BMIs than those with prediabetes who did not use metformin. Those who used metformin were also more likely to be aware of their prediabetes and to have a personal history of gestational diabetes mellitus or a family history of diabetes. After consideration of perceived threat, perceived benefits, self-efficacy, and cues to action, the only independent predictors of metformin use were younger age, female sex, higher BMI, and cues to action, most specifically, a doctor offering metformin therapy. CONCLUSIONS Demographic and clinical factors and cues to action impact the likelihood of metformin use for diabetes prevention. Perceived threat, perceived benefits, and self-efficacy were not independently associated with metformin use. These results highlight the importance of patient-centered primary care and shared decision-making in diabetes prevention. Clinicians should proactively offer metformin to patients with prediabetes to facilitate effective diabetes prevention.

中文翻译：

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患有糖尿病前期的参保成年人与二甲双胍使用相关的健康信念


目的 使用健康信念模型 (HBM) 框架探讨与成人糖尿病前期患者使用二甲双胍相关的因素。研究设计和方法 我们分析了来自大量参保劳动力的 200 名二甲双胍使用者和 1,277 名患有糖尿病前期的非二甲双胍使用者的调查数据。所有受试者均免费接受国家糖尿病预防计划 (DPP)。我们构建了双变量和多变量模型来研究感知威胁、感知利益、自我效能和行动线索如何影响二甲双胍的使用，以及人口、临床、社会心理学和结构变量如何影响这些关联。结果 与不使用二甲双胍的糖尿病前期患者相比，使用二甲双胍的糖尿病前期患者更年轻，女性的可能性更大，自评健康状况更差，BMI 更高。使用二甲双胍的人也更有可能意识到自己患有糖尿病前期，并且有妊娠糖尿病个人史或糖尿病家族史。在考虑了感知威胁、感知利益、自我效能和行动线索后，二甲双胍使用的唯一独立预测因素是年龄较小、女性、较高的体重指数和行动线索，最具体地说是提供二甲双胍治疗的医生。结论 人口统计学和临床​​因素以及行动线索影响二甲双胍用于糖尿病预防的可能性。感知威胁、感知利益和自我效能与二甲双胍的使用并不独立相关。这些结果凸显了以患者为中心的初级保健和共同决策在糖尿病预防中的重要性。临床医生应主动向糖尿病前期患者提供二甲双胍，以促进有效的糖尿病预防。