A nationwide wastewater-based assessment of metformin consumption across Australia

Dan Yang; Qiuda Zheng; Phong K Thai; Fahad Ahmed; Jake W O'Brien; Jochen F Mueller; Kevin V Thomas; Ben Tscharke

doi:10.1016/j.envint.2022.107282

A nationwide wastewater-based assessment of metformin consumption across Australia

Environ Int. 2022 Jul:165:107282. doi: 10.1016/j.envint.2022.107282. Epub 2022 May 6.

Authors

Dan Yang¹, Qiuda Zheng², Phong K Thai³, Fahad Ahmed³, Jake W O'Brien³, Jochen F Mueller³, Kevin V Thomas³, Ben Tscharke³

Affiliations

¹ Queensland Alliance for Environmental Health Sciences (QAEHS), The University of Queensland, 20 Cornwall Street, Woolloongabba, Queensland 4102, Australia; Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment, Department of Medical Oncology, Chongqing University Cancer Hospital, Chongqing 400030, China.
² Queensland Alliance for Environmental Health Sciences (QAEHS), The University of Queensland, 20 Cornwall Street, Woolloongabba, Queensland 4102, Australia. Electronic address: q.zheng@uq.edu.au.
³ Queensland Alliance for Environmental Health Sciences (QAEHS), The University of Queensland, 20 Cornwall Street, Woolloongabba, Queensland 4102, Australia.

PMID: 35597112
DOI: 10.1016/j.envint.2022.107282

Abstract

Metformin is the most widely used drug to treat type 2 diabetes. Monitoring spatial patterns of metformin use could provide new insights into treatment of type 2 diabetes and the distribution among populations. This study applied a wastewater-based epidemiological (WBE) approach to estimate metformin use in different populations across Australia and compared these estimates with traditional approaches of surveys and prescription data. Twenty-four-hour influent samples were collected from 75 wastewater treatment plants (WWTPs) across Australia in 2016 and analysed for metformin. Metformin was detected in all samples ranging in concentration from 8.2 to 191 µg/L (median 58 µg/L). Concentrations were converted to population-weighted average consumption at the national level, resulting in an average consumption of 28.6 g/day/1000 people across Australia, which was within 7% of estimates from national prescription statistics. In addition, results for five out of seven states had an estimated prevalence of type 2 diabetes within 20% compared to the traditional epidemiology surveys. Spatial patterns were also observed between urban and rural settings, with higher consumption rates of metformin found in Major Cities (22.5 ± 10.9 g/d/1000 people) and Inner Regional cities (25.4 ± 13.4 g/d/1000 people) than in Outer Regional (17.0 ± 8.1 g/d/1000 people) and Remote areas (15.1 ± 7.4 g/d/1000 people). Consumption estimates were also correlated against socioeconomic factors of the specific catchment areas. Greater metformin use was correlated with populations of lower education and income levels, while positive correlations were found between metformin consumption and consumption of allopurinol, caffeine and venlafaxine. Our study provides more evidence on the distribution of metformin use across Australia, which can be used to develop public health strategies to reduce the overall burden of type 2 diabetes in specific regions.

Keywords: Metformin; Socio-economic factors; Spatial pattern; Type 2 diabetes; Wastewater.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Australia / epidemiology
Diabetes Mellitus, Type 2* / epidemiology
Humans
Metformin* / analysis
Metformin* / therapeutic use
Wastewater / analysis
Wastewater-Based Epidemiological Monitoring
Water Pollutants, Chemical* / analysis

Substances

Waste Water
Water Pollutants, Chemical
Metformin