ArticlePediatric diabetes2021
Real-world treatment escalation from metformin monotherapy in youth-onset Type 2 diabetes mellitus: A retrospective cohort study.
Article in Pediatric diabetes, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.
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Who cites it
6 citing papers in PubMed.
- A Comparison of SGLT2 or DPP-4 Inhibitor Monotherapy vs Placebo for Type 2 Diabetes in Adolescents vs Young Adults.Journal of the Endocrine Society · 2025Article
- Mapping Barriers and Interventions to Diabetes Self-Management in Latino Youth: A Scoping Review.Children (Basel, Switzerland) · 2025Review
- Comparison of clinical characteristics and disease burden between early- and late-onset type 2 diabetes patients: a population-based cohort study.BMC public health · 2023Article
- Glucagon-like Peptide-1 Receptor Agonists for the Treatment of Type 2 Diabetes in Youth.TouchREVIEWS in endocrinology · 2023Review
- Progression from prediabetes to type 2 diabetes mellitus in adolescents: a real world experience.Frontiers in clinical diabetes and healthcare · 2023Article
- Metformin therapy in pediatric type 2 diabetes mellitus and its comorbidities: A review.Frontiers in endocrinology · 2022Review
Corrections and comments
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Authors and funding
6 authors.
Funding
Abstract
backgroundDue 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.
objectiveTo investigate patterns and predictors of treatment escalation within 5 years of metformin monotherapy initiation for youth with Type 2 diabetes in clinical practice. SUBJECTS: Commercially-insured patients with incident youth-onset (10-18 years) Type 2 diabetes initially treated with metformin only.
methodsRetrospective 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).
resultsThe 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.
conclusionsIn 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.
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