GLP-1RA Dispensing in Youth With Type 2 Diabetes: 2020 to 2023

Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are a novel pharmacotherapeutic option for pediatric type 2 diabetes (T2D); however, little is known about their current use. This study evaluated trends in GLP-1RA dispensing in youth with T2D between 2020 and 2023 and compared use by insurance type (ie, Medicaid vs commercial).

We conducted a multiyear cross-sectional study of youth aged 10 to 17 years with T2D using Merative™ MarketScan® Multi-State Medicaid and Commercial Database claims and encounters data (2020-2023). Annual prevalence of GLP-1RA dispensing was calculated for each year. Temporal trends in dispensing were examined using the Cochran-Armitage test. Poisson regression with robust variance estimated adjusted prevalence ratios (aPRs) were used to evaluate associations between insurance type (ie, Medicaid vs commercial) and GLP-1RA dispensing in 2023.

Annual prevalence of GLP-1RA dispensing in youth with T2D increased from 10.9% in 2020 to 35.6% in 2023 (P value for trend < .001) but remained less frequent than long- (49.5%) and short-acting insulin (43.4%). In 2023, overall GLP-1RA dispensing was similar for Medicaid-insured and commercially insured youth; however, the types of GLP-1RA differed by insurance. Medicaid-insured youth were less likely than commercially insured youth to be dispensed semaglutide (aPR 0.3, 95% CI: 0.2-0.4) and more likely to be dispensed dulaglutide (aPR 1.5, 95% CI: 1.2-2.0), exenatide (aPR 2.3, 95% CI: 1.2-4.2), or liraglutide (aPR 1.6, 95% CI: 1.2-2.1).

GLP-1RA dispensing increased in youth with T2D, but the type of GLP-1RA differed by insurance type. Comparative effectiveness studies and research identifying barriers to GLP-1RA use are needed to ensure optimal treatment of youth with T2D.