The journal of pediatric pharmacology and therapeutics : JPPT : the official journal of PPAG · 2026
Characteristics of Youth With Type 2 Diabetes Prescribed Sodium-Glucose Cotransporter-2 Inhibitors Surrounding FDA Approval at an Academic Pediatric Medical Center.
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Choi Erika Y, Nichols Presley, Jergel Andrew, Hao Shuai, Hsia Daniel S
Аннотация
OBJECTIVE: Sodium-glucose cotransporter-2 inhibitors (SGLT2i) were approved by the United States Food and Drug Administration (FDA) for the treatment of type 2 diabetes mellitus (T2DM) in children aged 10 years and older on June 20, 2023. We describe SGLT2i prescribing trends among all specialties at a quaternary care pediatric medical center surrounding the approval of empagliflozin, then identify characteristics of patients with T2DM associated with a higher likelihood of SGLT2i prescription by pediatric endocrinologists.
METHODS: We compared the total number of new SGLT2i prescriptions sent by all specialties before and after FDA approval of empagliflozin, between July 1, 2022, and June 30, 2024. We then identified children aged 10 years and older with T2DM who were newly prescribed an SGLT2i by pediatric endocrinologists. Demographic and clinical characteristics were compared with those of children with T2DM not prescribed SGLT2i.
RESULTS: The number of SGLT2i prescriptions sent by pediatric endocrinologists increased, and the top prescribing specialty shifted from Cardiology to Endocrinology. Increasing glycosylated hemoglobin (HbA1c) was associated with higher odds of SGLT2i prescription (OR 1.2 [95% CI, 1.1-1.3]; p < 0.001) regardless of empagliflozin approval status, low-density lipoprotein cholesterol, or urine microalbumin/creatinine ratio. Those prescribed SGLT2i before FDA approval were older, male, more frequently on insulin, and less frequently on metformin. These differences between groups were not seen post-approval.
CONCLUSIONS: SGLT2is were more likely to be prescribed for youth with higher HBA1c by pediatric endocrinologists. The presence of risk factors for cardiovascular or renal disease was less important in the decision to prescribe SGLT2i, despite their reno- and cardioprotective effects in adults. Prospective and qualitative data would be useful in further understanding prescribing practices.
METHODS: We compared the total number of new SGLT2i prescriptions sent by all specialties before and after FDA approval of empagliflozin, between July 1, 2022, and June 30, 2024. We then identified children aged 10 years and older with T2DM who were newly prescribed an SGLT2i by pediatric endocrinologists. Demographic and clinical characteristics were compared with those of children with T2DM not prescribed SGLT2i.
RESULTS: The number of SGLT2i prescriptions sent by pediatric endocrinologists increased, and the top prescribing specialty shifted from Cardiology to Endocrinology. Increasing glycosylated hemoglobin (HbA1c) was associated with higher odds of SGLT2i prescription (OR 1.2 [95% CI, 1.1-1.3]; p < 0.001) regardless of empagliflozin approval status, low-density lipoprotein cholesterol, or urine microalbumin/creatinine ratio. Those prescribed SGLT2i before FDA approval were older, male, more frequently on insulin, and less frequently on metformin. These differences between groups were not seen post-approval.
CONCLUSIONS: SGLT2is were more likely to be prescribed for youth with higher HBA1c by pediatric endocrinologists. The presence of risk factors for cardiovascular or renal disease was less important in the decision to prescribe SGLT2i, despite their reno- and cardioprotective effects in adults. Prospective and qualitative data would be useful in further understanding prescribing practices.