Prescribing Trends for the Outpatient Treatment of Adolescents and Young Adults with Type 2 Diabetes Mellitus
AUTHORS: Hanna Phan, Kyle Porter, Bruce Sill, Milap C. Nahata
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SUMMARY: BACKGROUND: Little is known about U.S. outpatient prescribing trends for type 2 diabetes (T2DM) in adolescents and young adults.
OBJECTIVES: To determine (a) trends in the outpatient prescribing of pharmacological and nonpharmacological therapies and (b) factors influencing prescribing trends for adolescents and young adults with T2DM.
METHODS: A retrospective, cross-sectional analysis was conducted on office visits of adolescents (12-17 years) and young adults (18-39 years) with T2DM or impaired glucose tolerance (IGT), using the National Ambulatory Medical Care Survey (NAMCS) from 1996-2005. Logistic regression was used to test for prescribing trends over time.
RESULTS: There were an estimated 1.6 million (93.7% T2DM; 4.4% T2DM + IGT; 1.9% IGT) and 22.2 million (88.1% T2DM; 11.9% IGT) office visits for adolescents (0.4% of all adolescent visits) and young adults (1.2% of all young adult visits) associated with T2DM based on ICD-9-CM codes, respectively. In young adults, diabetes drug mentions increased significantly from 39% of visits with T2DM to 61% in 2004-2005 (P = 0.04). Oral diabetes medication mentions increased from 20% to 49% (P = 0.001). However, reports of nonpharmacological therapy decreased from 53% in 1996-1997 to 37% in 2004-2005 (P = 0.14).
CONCLUSIONS: The prescribing of pharmacological treatment for T2DM increased with emphasis on oral agents, while reports of nonpharmacological therapy for T2DM decreased over the 9-year study period with increased use of oral medications in both adolescents and young adults. Health care providers should consistently consider both treatment approaches when prescribing patient care as recommended by treatment guidelines.