Utilization and Predictors of Adjuvant Metformin for Children and Adolescents on Mixed Receptor Antagonists (Second-Generation Antipsychotics).
Utilization and Predictors of Adjuvant Metformin for Children and Adolescents on Mixed Receptor Antagonists (Second-Generation Antipsychotics).
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儿童和青少年混合受体拮抗剂（第二代抗精神病药）辅助二甲双胍的利用和预测。
DOI：
10.1016/j.jaac.2023.02.017
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发表时间：
2023
影响因子：
13.3
通讯作者：
Calarge,Chadi
中科院分区：
文献类型：
--
作者：
Chen,Hua;Lyu,Ning;Chan,Wenyaw;DeLaCruz,Austin;Calarge,Chadi
目的了解儿童混合受体拮抗剂(SGA)受试者中二甲双胍的使用情况及其影响因素。符合条件的个人是6-17岁的儿童，拥有新的SGA处方至少90天。分别使用条件Logistic回归和Logistic回归分析对一般儿童和非肥胖儿童SGA患者开出二甲双胍佐剂的预测因素。结果在30,009名儿童SGA患者中，2.3%(n=785)接受了二甲双胍辅助治疗。在服用二甲双胍前6个月内有BMI z评分记录的597名患者中，83%为肥胖，34%为高血糖或糖尿病。高基线体重指数z评分(OR，95%CI：3.5，2.8-4.5，p<；0.0001)、有高血糖或糖尿病(OR，95%CI：5.3，3.4-8.3，p<；0.0001)，与没有改变相比，经历了从代谢风险较高的SGA转换到较低风险的SGA(OR，95%CI：9.9，3.5-27.5，p=0.0025)或相反方向的转换(OR，95%CI：4.1，2.1-7.9，p=0.0051)。与肥胖患者相比，非肥胖患者在服用二甲双胍前BMI z-Score速度更有可能为正。接受精神卫生专家指定的指标SGA与接受佐剂二甲双胍的可能性和在肥胖发生之前接受二甲双胍的可能性较高有关。结论儿童SGA接受者中使用二甲双胍的情况并不常见，非肥胖儿童早期使用二甲双胍的情况也很少见。
ObjectiveThe objective was to examine the utilization and predictors of adjuvant metformin among pediatric SGA (mixed receptor antagonist) recipients.MethodThis study uses 2016 to 2021 data of a national electronic medical record database. Eligible individuals are children aged 6-17 with a new SGA prescription for at least 90 days. Predictors of prescribing adjuvant metformin in general and to non-obese pediatric SGA recipients, in particular, assessed using conditional logistic regression and logistic regression analyses respectively.ResultsOf 30,009 pediatric SGA recipients identified, 2.3%(n= 785) received adjuvant metformin. Among the 597 with a BMI z-score documented during the 6-month period prior to metformin initiation, 83% were obese and 34% had either hyperglycemia or diabetes. Significant predictors for metformin prescribing were high baseline BMI z-score (OR, 95% CI: 3.5, 2.8-4.5, p< 0.0001), having hyperglycemia or diabetes (OR, 95% CI: 5.3, 3.4-8.3, p< 0.0001), undergoing a switch from a higher metabolic risk SGA to a lower risk one (OR, 95% CI: 9.9, 3.5-27.5, p= 0.0025), or a switch in the opposite direction (OR, 95% CI: 4.1, 2.1-7.9, p= 0.0051) compared to no switch. Nonobese metformin users were more likely to have a positive BMI z-score velocity before metformin initiation than their obese counterparts. Receiving the index SGA prescribed by a mental health specialist was associated with higher likelihood of receiving adjuvant metformin and receiving metformin before the development of obesity.ConclusionThe utilization of adjuvant metformin among pediatric SGA recipients is uncommon, and the early introduction of the medication among nonobese children is rare.