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Joshua N. Liberman, PhD; Jan E. Berger, MD; Meredith Lewis, BS

Arch Pediatr Adolesc Med. 2009;163(4):357-364.

Objective  To document trends in the use of prescription medications indicated for types 1 and 2 diabetes mellitus, hypertension, and dyslipidemia among children and adolescents.

Design  Serial, cross-sectional study.

Setting  Age-eligible children and adolescents with prescription drug benefits managed by CVS Caremark, a pharmacy benefits manager.

Participants  Commercially insured US children and adolescents aged 6 to 18 years. Population size varied by month from approximately 5.3 million to 6 million individuals.

Main Outcome Measure  Monthly prevalence of prescription drug use, measured from September 1, 2004, through June 30, 2007.

Results  The 1-month prevalence of antihypertensive, dyslipidemic, or oral antidiabetic medication or insulin use increased 15.2% from 3.3 per 1000 youths in November 2004 to 3.8 per 1000 youths in June 2007. The 16- to 18-year-olds had the highest prevalence overall, but the greatest rate of increase was found among 6- to 11-year-olds: 18.7% for girls and 17.3% for boys. Among antihypertensive medications, β-blockers had the highest prevalence (1.5 per 1000 youths), followed by angiotensin-converting enzyme inhibitors, diuretics, calcium channel blockers, and angiotensin II receptor blockers. For 6- to 11-year-olds, angiotensin-converting enzyme inhibitor use increased 27.7% among girls and 25.2% among boys. Dyslipidemia therapy, which was dominated by statin use, declined 22.9%.

Conclusions  The increasing use of oral antidiabetic and antihypertensive pharmacotherapy among children and adolescents, especially in the younger age group, indicates either an increased awareness of treatment needs or increased incidence of cardiovascular risk factors typically associated with adult populations. The decrease in treatment of dyslipidemia may reflect the ongoing controversy regarding statin use.

Author Affiliations: Department of Analytics & Outcomes, CVS Caremark, Hunt Valley, Maryland (Dr Liberman and Ms Lewis), and Northbrook, Illinois (Dr Berger). Dr Berger is now with Health Intelligence Partners, Chicago, Illinois.

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