Age, metformin adherence linked to treatment escalation in pediatric type 2 diabetes

Source/Disclosures Published by:

Source:

Vajravelu ME, et al. 21-OF. Presented at: American Diabetes Association Scientific Sessions; June 25-29, 2021 (virtual meeting).

disclosures:
Vajravelu does not report any relevant financial disclosures. See the presentation summary for all relevant financial disclosures from other authors.

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Young people who have type 2 diabetes at an older age and those who are on metformin therapy are more likely to receive therapy with insulin or a non-insulin antihyperglycemic agent, according to one speaker.

Mary Ellen Vajravelu

“Adolescents with type 2 diabetes have very few treatment options, and the younger the diagnosis, the longer it takes to escalate treatment with therapies beyond metformin,” Mary Ellen Vajravelu, MD, MSHP, a pediatric endocrinologist at Philadelphia Children’s Hospital told Healio. “Additional therapeutic options are critical for pediatric type 2 diabetes. Until they are available, younger adolescents are more likely to wait long periods of time before progressing treatment beyond metformin.”

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Vajravelu presented the findings at the virtual American Diabetes Association Scientific Sessions.

Researchers conducted a retrospective cohort study of 829 youth ages 10 to 18 with type 2 diabetes who were initially treated with metformin alone (66% girls; median age, 15 years; 19% Hispanic; 16% Black). Data, including age, gender, race and ethnicity, co-morbidities, and metformin adherence were obtained from a database of medical claims from 2000 to 2019. Adherence to metformin was derived from medication refill. Researchers also collected data on the use of insulin and non-insulin antihyperglycemics for each young person, along with the order of treatment escalation.

From the study cohort, 198 underwent treatment escalations within 5 years of starting metformin. Eighty-eight children were prescribed insulin and 164 young people used a non-insulin antidiabetic drug. There were 45 adolescents who were prescribed both insulin and a non-insulin antihyperglycemic agent. Younger participants were more likely to be prescribed insulin as the first or only antihyperglycemic drug.

“Type 2 diabetes drugs that are approved for adults are used off-label in children, more often in older adolescents but even in young people as young as 11 or 12 years old,” Vajravelu said.

Young people were more likely to escalate treatment if they were older at diagnosis (HR = 1.14; 95% CI 1.07-1.22). Hispanic adolescents were more likely to experience treatment escalation compared to other ethnicities (HR = 1.83). Youth who adhered to metformin were also more likely to experience treatment escalation (HR = 4.1). In univariate analysis, increases in HbA1c were associated with a greater likelihood of treatment escalation (HR = 1.4; 95% CI 1.2-1.6).

Both Hispanic participants (HR = 2.3) and black youth (HR = 2.3) were more likely to escalate treatment to insulin. Participants with complications (HR = 9.8) and those on metformin (HR = 3) were also more likely to switch to insulin treatment. For non-insulin antihyperglycaemic agents, only age (HR = 1.2) and metformin adherence (HR = 4.1) were associated with treatment escalation.

“Adherence to therapy, as measured by medication refill, plays a big role in treatment escalation,” Vajravelu said. “This makes clinical sense – if a patient is not taking the medication as prescribed, the first step would be to improve adherence. However, it can lead to a lack of treatment escalation despite a prolonged period of poor glycemic control.”

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American Diabetes Association Scientific Sessions

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