To describe the patterns of non-insulin antidiabetic medication use, initiation, and adherence in the pediatric population.
We conducted a descriptive study of non-insulin antidiabetic medication use in children and adolescents (10-18 years) using real-world data from a nationwide US commercial claims database (January 2004-September 2019). Trends in the prevalence of non-insulin antidiabetic medication use overall and by class were evaluated. Among new users of non-insulin antidiabetic agents, medication adherence was examined using group-based trajectory models.
In a cohort of >1 million pediatric patients, the prevalence of any non-insulin antidiabetic medication use was 75.7 per 100,000 patients in 2004 and more than doubled to 162.0 per 100,000 in 2019. Biguanides (metformin) was by far the most widely used medication class. The use of newer classes was low (<10 per 100,000), but there was an uptake in the use of GLP-1 agonists after liraglutide received pediatric approval in 2019. Medication adherence was poor during the 18 months after treatment initiation: 79.6% of initiators experienced an early treatment interruption (median time to interruption: 90 days among metformin monotherapy initiators), and 21% of initiators did not return for a prescription refill after the first month.
There was a substantial increase in non-insulin antidiabetic medication use among commercially-insured pediatric patients between 2004 and 2019. Nearly all patients were treated with metformin, while the use of newer agents remained low. Despite the increase in medication use, short treatment episodes were observed, even among patients with a diagnosis of type 2 diabetes, raising concern for poor adherence. This article is protected by copyright. All rights reserved.