Healthy Skepticism Library item: 10105

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Publication type: news

Study: Diabetes drug use spikes in girls
Associated Press 2007 May 16
http://www.usatoday.com/news/health/2007-05-16-diabetes-drug_N.htm

Full text:

TRENTON, N.J. (AP) – The number of adolescent girls taking drugs for Type 2 diabetes nearly tripled in just five years, while use of chronic medicines for psychotic behavior and insomnia roughly doubled among boys and girls aged 10 to 19, a study shows.

Meanwhile, adolescents’ use of drugs for depression and attention deficit hyperactivity disorder, or ADHD, leveled off or dropped in the last two years, after widespread new warnings about safety concerns.

The study, an analysis of prescription drug use from 2001 to 2006 among 370,000 insured children aged 10 to 19, was conducted by Medco Health Inc. of Franklin Lakes, N.J., the country’s biggest prescription benefit manager, and released exclusively to the Associated Press.

Experts say the findings raise questions about physical and mental health problems in youth, the appropriateness of putting them on strong, long-term medicines mostly designed for adults, and whether it might be better to focus on other strategies, such as counseling, exercise and changes in diet, caffeine intake and bedtime routine.

“There’s increasing use of medication in children the last 20 years, but does that mean we’re treating them successfully or that we’re overmedicating?” said Dr. Thomas Insel, director of the National Institute of Mental Health. Probably both, he said, but some children aren’t getting needed help.

Dr. Wayne Snodgrass, chairman of the American Academy of Pediatrics’ committee on drugs, said the levels of medication usage found in the study might be appropriate, but it’s hard to know without details on why each prescription was written.

“It deserves watching,” he said, particularly because adolescents’ brains are still developing. Snodgrass said worried parents should question their child’s doctor about their treatment or seek a second opinion.

The most striking trend was a 167% spike in girls 10 to 19 taking pills for type 2 diabetes, formerly called adult-onset diabetes. Medco found it jumped from 0.1% in 2001 to 0.27% in 2006; among boys, prevalence up 33%, to 0.08%.

Dr. John Buse, president-elect of the American Diabetes Association, said those figures are a bit higher than prior data but track U.S. increases in diabetes and obesity the past 15 years.

“It’s really scary to think about people in their teens developing a disease that in the past only developed in the 40s, 50s and 60s,” Buse said.

The big gap between the sexes, he said, likely is partly due to girls taking a generic diabetes drug, metformin, linked to weight loss and also prescribed for a hormonal condition that involves abnormal insulin function, causes male sex traits and increases cancer risk.

Also, hormone changes in puberty can trigger insulin resistance, or prediabetes. Puberty starts a couple years earlier in girls, so many more girls than boys in the study were in puberty.

Medco found prevalence of kids taking anti-psychotic drugs, once called major tranquilizers, roughly doubled, with about 1.2% of boys and 0.75% of girls taking them in 2006.

Widely used anti-psychotic drugs – including Risperdal, Zyprexa, Seroquel and Clozaril – are approved for treating schizophrenia and bipolar disorder in adults, but not children.

Insel said the drugs often are prescribed for kids for disruptive behavior and other unapproved uses, particularly to kids previously on antidepressants and ADHD drugs.

A federal survey of doctors’ office practices estimated a sixfold jump from 1993 to 2002 in patients aged 20 or younger prescribed anti-psychotic drugs, to 1.224 million. It found 38% of those prescriptions were for disruptive behavior such as ADHD, 32% were for mood disorders including depression, 17% were for developmental disorders such as mental retardation and autism, and 14% were for psychotic disorders such as schizophrenia.

Meanwhile, Medco found use of prescription sleeping pills nearly doubled, to about 0.3% of boys and 0.44% of girls.

“The fact that these kids have to get a prescription pill to go to sleep at night is amazing,” said Dr. Robert Epstein, Medco’s chief medical official, adding parents should try slowing kids down at night with curfews on caffeine and computer use, for example.

He said Medco’s numbers reflect drug use among adolescents covered by private or government insurance, but in general kids in the Medicaid program use more prescription medications and those with no insurance take significantly less.

Use of ADHD drugs leveled off in girls in 2006 at 3.5% and dropped in boys to almost 8%, while antidepressant use dropped in both sexes in 2005 and 2006, to about 4% of girls and 3.2% of boys.

Insel said those trends make sense, given that after the drugs ago got stringent warnings about problems such as suicidal thoughts a couple years ago, many parents became concerned about side effects and pediatricians worried about their liability for prescribing the drugs.