Professor of Pediatrics Cincinnati Children's Hospital Medical Center cin, Ohio, United States
Background: Childhood obesity is a chronic condition with many comorbidities that requires a multifaceted treatment approach, which can include pharmacologic intervention in addition to lifestyle modification. With the recent American Academy of Pediatric Recommendations supporting the heightened use of pharmacotherapy and the recent U.S. Food and Drug Administration’s approval of glucagon-like peptide receptor agonists (GLP1-RAs) for treatment in pediatric patients with obesity, there is increased interest in the use of these drugs in pediatric patients. There are concerns, however, whether cost, insurance coverage, and/or provider prescribing practices will lead to inequities with GLP-1-RA, with potentially unequal access for patients in minority and low-income populations. Several adult studies have demonstrated phamacoinequites in these groups. Thus, it is essential to understand the prescribing habits of providers treating childhood obesity. Objective: The objective of this study was to describe the GPL1-RA prescribing practices of pediatricians in a tertiary pediatric weight management program (PWMP). Design/Methods: We retrospectively reviewed charts of patients (n = 2,563) presenting to the Center for Better Health and Nutrition (a larger midwestern PWMP with 4 pediatricians) from 7/1/2021-6/30/2023. We compared descriptive data for patients who were prescribed GLP1-RAs, metformin only, or no Metformin or GLP1-RA. Descriptive data included race, ethnicity, sex, age, maximum HbA1c, maximum ALT, insurance (public or private), age at maximum BMI, and maximum %BMIp95. Univariate and multivariate logistic regression was performed using the same descriptive categories. Results: The average patient age was 13.79 years (range 1 to 28 years) 55% were female, 47% were White, 38% were Black, 8% were Hispanic, and 48% were Medicaid-insured. Of the 2,563 patients, 182 (7%) received a prescription for a GLP1-RA. Patients who were prescribed GLP1-RAs had higher maximum HbA1c (6.9% vs. 5.6%; p< 0.001), maximum ALT, (39 U/L vs. 26 U/L; p< 0.001), and maximum %BMIp95 (162 vs 143; p< 0.001) when compared to all other patients. There were no significant differences between the groups regarding race, ethnicity, insurance status, or sex.
Conclusion(s): Our analysis of GLP1-RA prescribing suggests that physicians are more likely to prescribe GLP1-RAs for patients with higher disease burden as measured by HbA1c, ALT, and BMI. Physician prescribing practice, however, does not appear to be influenced by race, ethnicity, or insurance status.
