Impact of metformin-induced gastrointestinal symptoms on quality of life and adherence in patients with type 2 diabetes

Hermes Florez, Jiacong Luo, Sumaya Castillo-Florez, Georgia Mitsi, John Hanna, Leonardo Tamariz, Ana Palacio, Sukumar Nagendran, Michael Hagan

Research output: Contribution to journalArticlepeer-review

62 Scopus citations


Aims: Gastrointestinal (GI) symptoms are common in patients with type 2 diabetes mellitus (T2DM). This study assesses the impact of 1) metformin on GI symptoms and health-related quality of life (HRQoL) and 2) metformin-associated GI symptoms on medication adherence in patients with type 2 diabetes newly beginning therapy. Methods: Patients with T2DM aged ≥ 18 years starting metformin from January to June 2007 who fi lled their prescriptions for ≥ 3 months were identifi ed from a health benefi ts company database. Via telephone, GI symptom impact was evaluated in a 360-patient sample using the validated Bowel Symptom Questionnaire and Medical Outcomes Study 36-Item Short-Form Health (SF-36) survey. Adherence was assessed using the medication possession ratio (MPR). Logistic regression adjusting for demographic and clinical covariates was used to assess the relationship between GI symptoms and MPR < 80%. Results: The most and least common GI symptoms reported were diarrhea (62.1%) and retching (21.1%), respectively. Most GI symptoms were associated with lower physical and mental HRQoL (P < 0.05). Most changes in specifi c HRQoL reached the minimum important difference of 3 points. Bloating, nausea, and abdominal pain were signifi cantly associated with MPR < 80%. Adjustment for demographic, clinical, and HRQoL factors made these relationships less evident. Conclusions: Metformin-associated GI symptoms in patients with T2DM lead to lower physical and mental HRQoL, which may result in patient nonadherence or physician reluctance to optimally titrate the metformin dose.

Original languageEnglish (US)
Pages (from-to)112-120
Number of pages9
JournalPostgraduate medicine
Issue number2
StatePublished - Mar 2010


  • Adherence
  • Health-related quality of life
  • Metformin
  • Type 2 diabetes

ASJC Scopus subject areas

  • Medicine(all)


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