Trends and Determinants of Oral Anti-Diabetic Initiation in Youth with Suspected Type 2 Diabetes.
OBJECTIVE
To evaluate trends and identify predictors of treatment initiation of oral anti-diabetic drugs (OAD) in youth.


METHODS
We identified a select population of children, ages 8-18 years, with at least 13 months of continuous health plan coverage within the years 2001-2012 in a large US commercial insurance claims database. New use of an OAD was defined as the first claim for an outpatient dispensing following a 12-month wash out period. Treatment incidence was estimated monthly over the study period, and stratified by age, gender, geographic region, and provider specialty.


RESULTS
The median size of the source population during the study period was 2.2 million children. A total of 13,824 initiators (mean monthly incidence of 4.6 (95% CI = 3.6, 5.5) per 100,000 youths) were identified. Initiators were more likely to be females, age 15-18, from the southern region, and have visited a family practitioner (versus a general pediatrician) prior to initiation. Time trends demonstrate a 43% increase in initiation from 2002-2012, with a gradual decrease starting from early 2008.


CONCLUSIONS
Incidence of filled OAD medications in youth increased over time, especially for patients treated by family practitioners. Additional research is needed into factors influencing prescribing by family practitioners and pediatricians.
Department of Epidemiology, UNC Gillings School of Global Public Health, Chapel Hill, NC, United States of America.
Mona
M
Cai
Department of Pediatrics, Division of Pediatric Gastroenterology, UNC School of Medicine, Chapel Hill, NC, United States of America.
Michael D
MD
Kappelman
CERobs Consulting, LLC, Chapel Hill, NC, United States of America.
Cynthia J
CJ
Girman
Department of Pediatrics, Division of Pediatric Endocrinology, UNC School of Medicine, Chapel Hill, NC, United States of America.
Nina
N
Jain
Department of Epidemiology, UNC Gillings School of Global Public Health, Chapel Hill, NC, United States of America.
Til
T
Stürmer
Department of Epidemiology, UNC Gillings School of Global Public Health, Chapel Hill, NC, United States of America.
Maurice Alan
MA
Brookhart
D000284:Administration, Oral; D000293:Adolescent; D017677:Age Distribution; D002648:Child; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy* / Q000453:epidemiology; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage* / Q000627:therapeutic use*; D015994:Incidence; D007348:Insurance, Health; D008297:Male
D007004:Hypoglycemic Agents