More U.S. Kids Taking Diabetes, Blood Pressure Drugs
MONDAY April 6, 2009 -- The number of American children and teens taking drugs to lower blood pressure and control diabetes has risen significantly since 2004, according to a new study.
The study is one of several reports on childhood obesity in the April issue of Archives of Pediatrics & Adolescent Medicine.
In the first report, researchers at CVS Caremark, a large supplier of medications to people with health insurance, used the company's drug database to track prescriptions filled on behalf of children and adolescents.
"Children and adolescents are starting to show signs of chronic health conditions and cardiovascular risk factors that are typically reserved for adults," said Joshua N. Liberman, vice president of strategic research at the company and the study's lead researcher. "We need to be educating health-care providers about the opportunities for managing these patients."
Blood pressure medications and diabetic oral drug use has been rising among children, Liberman noted. "We noted increases in all age groups [between] 6 to 18 years of age," he said. "The youngest age group, the 6-to-10-year population, realized the greatest increase in medication use."
For the study, Liberman's team examined the prescription records of almost 6 million U.S. children and adolescents from 6 to 18 years of age whose prescriptions were covered by private health insurance.
They found that prescriptions for blood pressure medications, diabetes medications and cholesterol-lowering drugs increased by more than 15 percent from 2004 to 2007, rising from 3.3 prescriptions per 1,000 children in late 2004 to 3.8 per 1,000 by mid-2007.
Assessed separately, diabetes medications charted a 23 percent rise, and there was a 15 percent jump in pediatric prescriptions for blood pressure medications, Liberman said.
However, over the same period, prescriptions for cholesterol-lowering medications (which include statin drugs such as Crestor, Lipitor and Zocor) dropped by almost 23 percent. The researchers speculate that this drop may have been due to controversy about prescribing these drugs to children.
However, the overall rise in diabetes and blood pressure medicines is "representative of commercially insured children throughout the United States," Liberman said.
Liberman blames the rise on one factor: the dramatic increase in obesity among children. But in addition, he said, doctors are becoming more aware of the health consequences of obesity among children and starting treatment early.
Dr. Goutham Rao, clinical director of the Weight Management and Wellness Center at Children's Hospital of Pittsburgh, said that "the relative increases in prescriptions of anti-hypertensive, anti-diabetic and lipid-lowering [cholesterol] medications isn't surprising, but attributing increasing prescription rates to increasing rates of obesity should be done cautiously."
"Physicians may actually be recognizing these problems better," Rao said. "In other words, it's not that the problems are becoming more common, but increasing awareness has led to increased rates of diagnosis."
The researchers seem to suggest that type 2 diabetes, high blood pressure and high cholesterol seem to be under-treated, Rao said, and they imply that this is because of physician discomfort with prescribing long-term medication for children.
"This is undoubtedly true," Rao said. "However, the researchers don't mention patient and parent discomfort. From personal experience, I can tell you that many parents are extremely uneasy with the idea of their son or daughter taking a lipid-lowering medication for the rest of his or her life. The idea that these problems affect children at all is still unfamiliar to many families."
Other findings on the childhood obesity problem are also reported in the journal. One study found that American Indian and Native Alaskan children are much more likely to be obese than are white and Asian children. In that study, Sarah E. Anderson, from Ohio State University College of Public Health, and Dr. Robert C. Whitaker, from Temple University, collected data on 8,550 children.
They found that about 18 percent of 4-year-olds in their study were obese in 2005 -- including more than 31 percent of American Indian/Native Alaskan children, 22 percent of Hispanic children, 21 percent of black children, 16 percent of white children and 13 percent of Asian children.
"To help arrest the trends in childhood obesity, both the surgeon general and the Institute of Medicine have recommended that obesity-prevention efforts begin early in life," the authors concluded.
In a third report, Dutch researchers led by Amika S. Singh at VU University Medical Center in Amsterdam found that a school-based effort to increase awareness of obesity and change behaviors could reduce adolescents' consumption of sugary beverages. The program boosted body composition in girls, but not boys, but did not seem to affect other behaviors, such as eating snacks or walking to school.
"Our findings are important, especially when considering the need for evidence on the long-term effectiveness of interventions in the field of obesity prevention," the authors wrote. "Reducing intake of sugar-containing beverages should therefore be considered a good behavioral target for future interventions aimed at the prevention of overweight among adolescents."
In a final report, a team led by Dr. Y. Claire Wang, from Columbia University's Mailman School of Public Health in New York City, found that getting children to drink water rather than sugary drinks such as sodas decreased their total daily calorie intake by an average of 235 calories a day. The benefit was not apparent when sweet drinks were replaced with milk or juice, however.
"Our results also indicate that replacing sugar-sweetened beverages with water is associated with a significant decrease in total energy intake," the authors wrote. "Each 1 percent of beverage replacement was associated with a 6.6-calorie lower total energy intake, a reduction not negated by compensatory increases in other food or beverages."
The Nemours Foundation has more on childhood obesity.
Posted: April 2009