Diabetes, blood pressure drug use up among children

The number of children prescribed blood pressure and diabetes medicines rose about 15 percent over three years, although the total number of youngsters and teens taking the drugs is relatively small, a study found.
For every 1,000 U.S. children ages 6 to 18, 3.8 were taking these medicines in 2007, according to research published last week in the Archives of Pediatrics and Adolescent Medicine. That compares with 3.3 in 2004. The authors estimated that 175,710 children and teens are being treated with medicines for diabetes, high blood pressure or cholesterol out of the 53.2 million children nationwide.
The increase is most likely because doctors are more vigilant about these conditions in children and more kids are overweight, said Sarah de Ferranti, director of the Preventive Cardiology Clinic at Children’s Hospital Boston, who wasn’t an author of the study. Obesity in children raises the risk of diabetes, high blood pressure and heart disease.
“We should all be concerned that children are requiring more medications to treat the consequences of obesity,” she said in an April 3 telephone interview. “If we’re not able as a society to approach this problem of childhood obesity more successfully, then we’re going to be exposing our children to medicines that may not be necessary.”
The study was done by researchers at Woonsocket-based CVS Caremark Corp., which funded the work. About 19 percent of U.S. children 6 to 11 are overweight or obese, the researchers said. The share is 17 percent among those 12 to 19.
The researchers measured use among insured children 6 to 18 whose prescriptions were handled by the company’s business that administers drug benefits for employers and health-insurance carriers.
Use was tracked from September 2004 through June 2007, with between 5.3 million and 6 million children included each month.
Those 16 to 18 were the most likely to use medicines for diabetes and high blood pressure, the researchers found. The biggest increase in use occurred in children 6 to 11.
Medicines called beta blockers, which include AstraZeneca Plc.’s Toprol XL, also available as a generic, were the most common treatments for high blood pressure in children. Those were followed by ACE inhibitors like Biovail Corp.’s Vasotec and generic forms of the drug enalapril. Insulin injection was the most common diabetes treatment. Metformin, the generic of Bristol-Myers Squibb Co.’s Glucophage, was the most common oral treatment for diabetes, the authors said.
The pharmaceutical claims didn’t include the diagnosis, said Joshua Liberman, the lead researcher and vice president of strategic research for CVS Caremark in Hunt Valley, Maryland.
“Clearly the literature has strongly indicated growth in the rate of obesity in the U.S., and the amount of attention that has received would likely translate to greater awareness to providers about the treatment options available,” Liberman said by telephone April 3.
The study found a 23 percent decrease in youngsters’ use of cholesterol-lowering treatments like statins, which include Bristol-Myers Squibb Co.’s Pravachol and its generic forms. The researchers said the decline may be because of the unknown effects of using that type of drug in young people long term.
The use of many of these medicines in children is “generally understudied,” and doctors and parents need to weigh the risks and benefits before deciding on treatment, de Ferranti said. She said she would use medicines if a child is diagnosed with diabetes or is at high risk of developing complications from high blood pressure, like a stroke or heart failure.
In July, the American Academy of Pediatrics changed its guidelines to say that children as young as 8 should take cholesterol-lowering drugs if diet changes alone fail to work. That report also recommended cholesterol screening for all overweight children.
Based on last week’s findings, the researchers projected that 78,361 U.S. children are being treated with insulin, while 23,358 are receiving an oral diabetes medicine and 79,055 are getting drugs for high blood pressure. About 150,000 U.S. children and adolescents have diabetes and between 1.1 million and 2.6 million have elevated blood pressure, they said.
The study suggests that the medicines aren’t being overused, said Stephen Daniels, chairman of the department of pediatrics at the University of Colorado in Denver, in an editorial accompanying the study.
“While the potential for misuse of these medications remains, that does not appear to be happening at this time,” Daniels wrote. •