666 - Patterns in Practice: A Retrospective Review of GLP-1 and SGLT2 Prescriptions in Pediatric Endocrinology at an Academic Medical Center

Publication Number: 4652.666

Audrey Duquette, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States; Wenya Chen, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States; Luis Lopez, Northwestern University The Feinberg School of Medicine, Chicago, IL, United States; Ngozi J. Okoli, Northwestern University The Feinberg School of Medicine, Chicago, IL, United States; Jisel Gomez, Northwestern University The Feinberg School of Medicine, Chicago, IL, United States; Nina Mondero, Emory University School of Medicine, Atlanta, GA, United States; Alexandra Perez, Nova Southeastern University College of Pharmacy, Davie, FL, United States; Monica E. Bianco, Northwestern University The Feinberg School of Medicine, Chicago, IL, United States

Background: The incidence and prevalence of pediatric Type 2 Diabetes Mellitus (T2DM) is rising, along with mounting evidence that pediatric T2DM is more aggressive than its adult counterpart. It is imperative that novel therapies with potential to halt or reverse disease progression be developed and deployed in clinical practice.

Objective: This study examines the integration of two recently approved antidiabetic agents for pediatric T2DM, Glucagon-like-peptide-1 receptor agonists (GLP-1) and sodium glucose cotranporter-2 inhibitors (SGLT2), into clinical management at Lurie Children’s Hospital from 2019 to 2024.

Design/Methods: Patients 10 years or older presenting with new onset T2DM between 01/01/2019 and 6/30/2024 were stratified according to whether they were prescribed a GLP-1 and/or SGLT2. Standard statistical tests were used to evaluate between-group differences in demographic and clinical characteristics and to characterize prescribing practices for GLP-1 and SGLT2. Joint models were used to investigate body mass index (BMI) and HgbA1c trajectories, and multivariable logistic regression was used to evaluate factors associated with receipt of a GLP-1 or SGLT2 prescription at an encounter. Cochran-Armitage Test was used to assess if the GLP-1 prescription rate increased across years.

Results: There were no clinically significant differences between the cohorts, with a median time from diagnosis to GLP-1 or SGLT2 initiation of 13 months and 30 months respectively. Patients prescribed a GLP-1 had a small but significant reduction in BMI over time [average reduction of 0.36 kg/m² per month (95% CI: -0.65, -0.07; p = 0.02)]. Patient BMI, HgbA1c, payor, and ethnicity did not affect the likelihood of GLP-1 or SGLT2 initiation, however providers in practice for > 10 years had 92% lower odds of prescribing as compared to providers < 5 years in practice (OR = 0.08; 95% CI: 0.01, 0.62; p = 0.02). Private insurance status demonstrated higher risk of GLP-1 discontinuation (hazard ratio (HR) = 2.14, 95% CI: 1.09, 4.11; p = 0.03). HgbA1c and GLP-1 prescription rate did not change significantly over the study period.

Conclusion(s): Targeted continuing education is critical to support timely adoption of emerging therapies, such as GLP-1s and SGLT2s, among experienced clinicians. Addressing disparities in insurance coverage of these medications is necessary to optimize access and outcomes. Lastly, leveraging positive metabolic effects of these medications as motivation for long-term adherence may further reduce morbidity and mortality in pediatric T2DM.