Background: Type 2 diabetes (T2D) is becoming more prevalent in adolescents. Multi-disciplinary care with periodic follow-up is required to ensure optimal management with lifestyle modification and medications. The purpose of this study was to estimate physician visitation rates and antidiabetic medication use (including off-label use) among adolescents with T2D and examine the impact of insurance type (Commercial vs. Medicaid).
Methods: We used data from the Truven MarketScan Commercial and Medicaid administrative claims databases to identify a cohort of adolescents aged 10-17 years with T2D (≥2 T2D diagnoses or ≥1 T2D diagnosis and ≥1 antidiabetic medication) with continuous medical and prescription enrollment in 2015. Patients with gestational diabetes, diabetes complicating pregnancy, and secondary diabetes were excluded. Visits to specified providers (pediatric endocrinologist, pediatrician, and family practitioner) and use of medications overall and by class were assessed.
Results: Substantially more commercially insured than Medicaid patients had ≥1 visit to any specified provider (88% vs. 45%) and to pediatric endocrinologists (33% vs. 14%). The use of any antidiabetic medication was similar in both insurance types (92% vs. 90%); however, off-label use was higher in commercially insured patients (9% vs. 6%), specifically those visiting only family practitioners (12%). The most commonly used off-label drug class was sulfonylureas.
Conclusions: A higher proportion of commercially insured adolescents received multi-disciplinary care. While use of any antidiabetic medication was similar, off-label use was greater among commercially insured. Concerted efforts are needed to enhance patient access, generate evidence regarding non-approved medications, and educate providers about optimal care of youth with T2D, particularly on the use of sulfonylureas, which are not recommended by current guidelines.
S. Curtis: Employee; Self; Eli Lilly and Company. Employee; Spouse/Partner; Eli Lilly and Company. J.A. Johnston: Employee; Self; Eli Lilly and Company. Stock/Shareholder; Self; Eli Lilly and Company. P.W. Anderson: Other Relationship; Self; Eli Lilly and Company. K.M. Schroeder: Employee; Self; Eli Lilly and Company. Stock/Shareholder; Self; Eli Lilly and Company. J. Wu: None. P. Zeitler: Consultant; Self; Daiichi Sankyo Company, Limited, Merck & Co., Inc., Eli Lilly and Company, Takeda Development Center Americas, Inc., Boehringer Ingelheim GmbH.