Preteens, teens doubled use of diabetes drugs

Dramatically higher prevalence of use among young girls vs. boys.

Use of antidiabetes medications increased by 166% among girls aged 10 to 14 years and 135% among girls aged 15 to 19 years between 2002 and 2005.

Data also revealed an increase in overall chronic medication use in children across all therapy classes — antihypertensives, antihyperlipidemics, antidepressants, asthma controllers and attention-deficit disorder and attention-deficit/hyperactivity disorder medications.

“Our study findings indicate that these increased levels of chronic medication use are symptoms of broader underlying issues affecting children today. These trends are worrisome, given that many of these therapies are treating conditions with modifiable risk factors and, if not addressed, many of these children will carry these chronic diseases into adulthood,” Emily R. Cox, RPh, PhD, senior director of research at Express Scripts Inc. in St. Louis, said in a press release.

Using ambulatory prescription claims data, the researchers estimated the trends and quarterly prevalence of chronic medication use in a nationally representative sample of more than 3.5 million children between 2002 and 2005.

Excluding asthma controllers, teens aged 15 to 19 years accounted for the largest percentage of children receiving chronic disease medications.

In 2002, or at baseline, chronic medication use ranged from 0.27 per 1,000 children receiving antihyperlipidemics to 29.5 per 1,000 children receiving asthma controllers. During the study period, prevalence of asthma medication use was 46.5%, followed by ADD and ADHD medications at 40.4% and antihyperlipidemics at 15%. The prevalence of use for antihypertensives and antidepressants was more moderate (1.8%).

Girls had a dramatically higher rate of growth for type 2 antidiabetes therapies compared with boys (147% vs. 39%). The researchers also reported higher rates of growth among girls for ADD and ADHD medications (63% vs. 33%) and antidepressants (7% vs. –4%).

The researchers indicated they could not explain this pattern, which is inconsistent with the patterns of obesity among boys and girls. However, increased physician office visits and screening rates — particularly for girls — could be a contributing factor, they said.

Children aged 5 to 9 years accounted for the largest increase (67.3%) in the use of asthma controllers compared with older children aged 10 to 14 years (38.8%) and 15 to 19 years (34.7%). According to the researchers, this could be explained by concerns about the long-term adverse events of these medications in children.

Long-term effects

The bad news, according to Donna R. Halloran, MD, MSPH, assistant professor of pediatrics at St. Louis University School of Medicine, is that there is more disease, due in large part to the increasing prevalence of childhood obesity.

“Our findings show that childhood obesity not only has long-term health implications but also impacts children’s immediate health,” she said in a press release.

The good news is that the findings “indicate that we, the doctors, are doing a better job of screening children and diagnosing chronic conditions. A great example of this is blood pressure, where there has been a big push to identify and treat children in need,” Halloran said. – by Katie Kalvaitis

Pediatrics. 2008;122:1053-1061.

With >15% of youth overweight and an additional >15% obese, we are seeing more insulin resistance and its associated comorbidities. The increased use of drugs to treat type 2 diabetes is far in excess of the increase in type 2 diabetes seen in children and youth. Although the researchers did not break down which antidiabetes medications have had increased numbers of prescriptions, I would guess that the biggest increase is metformin. Results of several studies demonstrated weight loss or, at least, decreased rate of weight gain with metformin, and I suspect that there are many pediatricians using this drug for weight loss. This is likely due to the lack of time and resources for adequate counseling and lack of efficacy of most office-based lifestyle modification programs.

The findings of the Princeton School Study and the Treatment Options for Type 2 Diabetes in Adolescents & Youth (TODAY) study indicated a 15% to 45% prevalence of impaired fasting glucose in overweight teens in a school setting. Thus, I expect there is increased prescribing of metformin for insulin resistance itself to treat the comorbidities. The female preponderance is likely due to treatment of polycystic ovary syndrome, a consequence of insulin resistance, as metformin is approved for this indication. The increase in prescribing patterns of lipid-lowering medications has not increased nearly as much as that of antidiabetes medications, despite the fact that dyslipidemia is more common in patients with insulin resistance than is abnormal carbohydrate metabolism. This either means that practitioners are attempting to improve lipids by improving insulin sensitivity or we are not adequately treating abnormal lipids when indicated.

– Janet Silverstein, MD

Endocrine Today Editorial Board member