American Diabetes Association Scientific Sessions

American Diabetes Association Scientific Sessions

Issue: August 2021
Source:

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

Disclosures: Vajravelu reports no relevant financial disclosures. Please see the presentation abstract for all other authors’ relevant financial disclosures.
June 26, 2021
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Age, metformin adherence linked to treatment escalation in pediatric type 2 diabetes

Issue: August 2021
Source:

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

Disclosures: Vajravelu reports no relevant financial disclosures. Please see the presentation abstract for all other authors’ relevant financial disclosures.
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Youths diagnosed with type 2 diabetes at an older age and those who adhere to metformin therapy are more likely to progress to therapy with insulin or a non-insulin antihyperglycemic agent, according to a speaker.

Mary Ellen Vajravelu

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

Diabetes child 2019
Source: Adobe Stock

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

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

Of the study cohort, 198 underwent treatment escalation within 5 years of metformin initiation. Eigjty-eight children were prescribed insulin, and 164 youths used a non-insulin antihyperglycemic agent. There were 45 youths prescribed both insulin and a non-insulin antihyperglycemic agent. Younger participants were more likely to have insulin prescribed as the initial or only antihyperglycemic.

“Type 2 diabetes medications that are approved for adults are being used off-label in children, more commonly in older adolescents but even in youth as young as 11 or 12 years,” Vajravelu said.

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

Both Hispanic participants (HR = 2.3) and Black youth (HR = 2.3) had a greater likelihood for treatment escalation to insulin. Participants with complications (HR = 9.8) and those who adhered to metformin (HR = 3) were also more likely to escalate to insulin treatment. For non-insulin antihyperglycemic agents, only age (HR = 1.2) and adherence to metformin (HR = 4.1) were associated with treatment escalation.

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