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• W3162252425 abstract "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.To investigate patterns and predictors of treatment escalation within 5 years of metformin monotherapy initiation for youth with Type 2 diabetes in clinical practice.Commercially-insured patients with incident youth-onset (10-18 years) Type 2 diabetes initially treated with metformin only.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).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.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." @default.
• W3162252425 created "2021-05-24" @default.
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• W3162252425 date "2021-06-30" @default.
• W3162252425 modified "2023-10-16" @default.
• W3162252425 title "<scp>Real‐world</scp> treatment escalation from metformin monotherapy in <scp>youth‐onset</scp> Type 2 diabetes mellitus: A retrospective cohort study" @default.
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• W3162252425 doi "https://doi.org/10.1111/pedi.13232" @default.
• W3162252425 hasPubMedCentralId "https://www.ncbi.nlm.nih.gov/pmc/articles/8373808" @default.
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