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Vajravelu ME, et al. 21-OR. Presented at: Scientific Sessions of the American Diabetes Association; 25-29 June 2021 (virtual meeting).
Disclosure:
Vajravelu does not report any relevant financial information. Please see the presentation summary for all relevant financial information from the other authors.
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Adolescents diagnosed with type 2 diabetes at an older age and those adhering to metformin therapy are more likely to switch to therapy with insulin or a non-insulin-based antihyperglycemic agent, according to a spokesman.
Mary Ellen Vajravelu
“Adolescents with type 2 diabetes have very few treatment options, and the younger the diagnosis, the longer it takes for treatment to escalate beyond metformin.” Mary Ellen Vajravelu, MD, MSHP, a pediatric endocrinologist at Philadelphia Children’s Hospital, said Healio. “In pediatric type 2 diabetes, additional therapy options are urgently required. Until these are available, younger adolescents must have rather long periods of time before treatment has progressed beyond metformin. “
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Vajravelu presented the results at the American Diabetes Association’s virtual scientific sessions.
The researchers conducted a retrospective cohort study of 829 adolescents aged 10 to 18 with type 2 diabetes initially treated with metformin only (66% girls; mean age 15 years; 19% Hispanics; 16% blacks). Data, including age, gender, race and ethnicity, comorbidities, and metformin adherence, were obtained from a database of medical claims from 2000 to 2019. Metformin adherence was derived from drug refills. The researchers also collected data on the use of insulin and insulin-free antihyperglycemia for each adolescent along with the order of treatment escalation.
198 of the study cohort experienced a therapy escalation within 5 years of starting metformin therapy. Eighty-eight children were prescribed insulin and 164 adolescents were using an insulin-free antihyperglycemia drug. Forty-five adolescents were prescribed both insulin and an insulin-free antihyperglycemic agent. Younger participants were more likely to be prescribed insulin as an initial or antihyperglycemic drug only.
“Type 2 diabetes drugs that are approved for adults are used off-label in children, more often in older teens, but even in teens 11 or 12 years old,” Vajravelu said.
Adolescents 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 races (HR = 1.83). Adolescents who stuck to metformin also had a higher chance of treatment escalation (HR = 4.1). In the univariate analysis, an increase in HbA1c was associated with a higher probability of treatment escalation (HR = 1.4; 95% CI 1.2-1.6).
Both Hispanic participants (HR = 2.3) and black adolescents (HR = 2.3) were more likely to experience treatment escalation to insulin. Participants with complications (HR = 9.8) and those on metformin (HR = 3) were also more likely to escalate to insulin treatment. In non-insulin antihyperglycaemia, only age (HR = 1.2) and compliance with metformin (HR = 4.1) were associated with treatment escalation.
“Adherence, as measured by drug refills, plays a big role in escalating treatment,” said Vajravelu. “It makes clinical sense – if a patient is not taking the drug as prescribed, the first step would be to improve adherence. However, it could lead to a lack of treatment escalation despite a longer period of poor glycemic control. “
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