Trends in Oral Anti-Diabetic Utilization and Factors Affecting Effectiveness in Children and Young Adults

Cai, Mona

Trends in Oral Anti-Diabetic Utilization and Factors Affecting Effectiveness in Children and Young Adults Public Deposited

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March 21, 2019

Creator

Cai, Mona
- Affiliation: Gillings School of Global Public Health, Department of Epidemiology

Abstract

Objectives: Our study quantified the trends in filled oral anti-diabetic (OAD) prescriptions, predictors of treatment initiation, and factors related to discontinuation and re-initiation among US privately insured children and adolescents from 2001-2012 Methods: Trends in treatment incidence were estimated monthly and stratified by baseline demographics. The cumulative risks of non-persistence at 30-days, 180-days, and 360-days were calculated and predictors of discontinuation were determined using Cox proportional hazards regression. Rates of re-initiation were summarized and predictors were evaluated using case-crossover analysis. Results: Time trends demonstrated an overall 43% increase in initiation from 2002 to 2012, with a gradual decrease observed beginning early 2008. Initiators were more likely to be females, age 15-18, from the southern region, and have visited a family practitioner prior to initiation. Among initiators, persistence was low and the cumulative risk of non-persistence at 180 days was 79.0%. However, 31.4% of patients with extended periods of without drug supply subsequently re-initiated therapy. Case-crossover analysis demonstrated that follow-up care of different forms were independently highly associated with re-initiation, including HbA1c testing during an outpatient visit (odds ratio (OR), 4.4; 95% CI, 3.6-5.5) and LDL testing during an outpatient visit (OR, 4.4; 95% CI, 3.3, 5.8). Single occurrences of HbA1c testing (OR, 4.1; 95% CI 3.4-5.0), LDL testing (OR 3.8; 95% CI 3.0-4.7), and being diagnosed with a type 2 diabetes complication (OR 3.0; 95% CI 2.2-4.2) were also strongly associated with treatment re-initiation. Conclusions: Incidence of filled OAD medications in youth has increased over time, especially in patients treated by family practitioners. Poor persistence to index drug was common in this population, although greater follow-up care by physicians may decrease the length or frequency of treatment gaps.

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