Real‐world treatment escalation from metformin monotherapy in youth‐onset Type 2 diabetes mellitus: A retrospective cohort study
Year: 2021
Type: article
Study design: Observational Study
Abstract: BACKGROUND: Due to high rates of comorbidities and rapid progression, youth with Type 2 diabetes may benefit from early and aggressive treatment. However, until 2019, the only approved medications for this population were metformin and insulin. OBJECTIVE: To investigate patterns and predictors of treatment escalation within 5 years of metformin monotherapy initiation for youth with Type 2 diabetes in clinical practice. SUBJECTS: Commercially-insured patients with incident youth-onset (10-18 years) Type 2 diabetes initially treated with metformin only. METHODS: Retrospective cohort study using a patient-level medical claims database with data from 2000 to 2020. Frequency and order of treatment escalation to insulin and non-insulin antihyperglycemics were determined and categorized by age at diagnosis. Cox proportional hazards regression was used to evaluate potential predictors of treatment escalation, including age, sex, race/ethnicity, comorbidities, complications, and metformin adherence (medication possession ratio ≥ 0.8). RESULTS: The cohort included 829 (66% female; median age at diagnosis 15 years; 19% Hispanic, 17% Black) patients, with median 2.9 year follow-up after metformin initiation. One-quarter underwent treatment escalation (n = 207; 88 to insulin, 164 to non-insulin antihyperglycemic). Younger patients were more likely to have insulin prescribed prior to other antihyperglycemics. Age at diagnosis (HR 1.14, 95% CI 1.07-1.21), medication adherence (HR 4.10, 95% CI 2.96-5.67), Hispanic ethnicity (HR 1.83, 95% CI 1.28-2.61), and diabetes-related complications (HR 1.78, 95% CI 1.15-2.74) were positively associated with treatment escalation. CONCLUSIONS: In clinical practice, treatment escalation for pediatric Type 2 diabetes differs with age. Off-label use of non-insulin antihyperglycemics occurs, most commonly among older adolescents.
Source: Pediatric Diabetes
DOI: 10.1111/pedi.13232
Language: English
Subfield: Endocrinology, Diabetes and Metabolism
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
Awards: Behavioral Economics for Activity Motivation in Adolescents and Young Adults with Pediatric Diabetes and Type 2 Diabetes, VIRTUUS Children's Study: Validating Injury to the Renal Transplant Using Urinary Signatures in Children, Conventional and Metabolomic Predictors of Pediatric Prediabetes & Insulin Resist, Cardiometabolic Health in Adolescents of South Asian Ancestry - the CHAriSmA study, Evaluation of the entero-insular (incretin) axis in cystic fibrosis-competitive renewal., TODAY2 Phase 2 (T2P2): Long-Term Post-Intervention Follow-Up, Career Development Program in Pediatric Diabetes Research (K12) at CHOP, Urological and Renal Disease Engaging Adolescents in Adherence Collaborative Trial, Target self-regulation to promote adherence and health behaviors in children, Institutional Clinical and Translational Science Award, Reaching Equity for Adults and CHildren in Transplant (REACH-TRANSPLANT), Michigan Center for Diabetes Translational Research, Michigan Diabetes Research Center (MDRC), Michigan Nutrition Obesity Research Center, Institutional Clinical and Translational Science Award, Translational Research Training in Pediatric Diabetes & Endocrinology
OpenAlex ID: W3162252425