The increase in the number of adolescents and young adults being prescribed glucagon-like peptide-1 (GLP-1) receptor agonists has been staggering in recent years, with data from pharmacy records showing a nearly 600% rise. From 2020 to 2023, the monthly prescriptions for these diabetes or weight-loss drugs in individuals aged 12 to 25 skyrocketed from 8,722 to 60,567. This surge represents a remarkable 594.4% growth rate, as revealed by a study conducted by Joyce M. Lee, MD, MPH, and colleagues from the University of Michigan Medical School in Ann Arbor. The prescription rates of all other pharmacy medications for this age group, however, experienced a decline of 3.1% during the same period, as highlighted in their research letter in JAMA.
The study’s findings also shed light on the fact that there were substantial increases in the dispensing of GLP-1 agonists, particularly among girls and young women. Girls accounted for a majority of the prescription fills in the study period, prompting speculation that societal biases towards weight may be influencing this disproportionate dispensing. Lee expressed surprise at the more pronounced increase in GLP-1 dispensing among females compared to males, with 60% of adolescents and 76.4% of young adults who received medications being female.
The GLP-1 receptor agonists included in the analysis – dulaglutide, exenatide, liraglutide, semaglutide, and tirzepatide – have seen a surge in prescriptions, given their approval for both diabetes and weight management purposes in varying age groups. While dulaglutide and exenatide are approved for adolescents and adults with type 2 diabetes, liraglutide and semaglutide are also approved for diabetes and weight management in both adults and pediatric patients. Tirzepatide, on the other hand, is approved for diabetes and weight management in adults exclusively.
Although GLP-1 medications like Wegovy received FDA approval for weight loss in adults in 2021 and adolescents in 2022, there is still limited knowledge about their utilization in younger patients. The rise in monthly GLP-1 agonist dispensing was substantial across both male adolescents (503.8% increase) and female adolescents (587.5% increase) from 2020 to 2023. Among young adults, there was also a significant surge in dispensing for both men (481.1% increase) and women (659.4% increase) during the same period.
The study also revealed interesting insights into the demographics of those being prescribed GLP-1 receptor agonists. Nearly half of adolescents and young adults receiving these medications resided in the Southern region of the United States. Moreover, Medicaid was the most common insurance coverage for adolescents (48%), while young adults were predominantly covered by commercial insurance (66.8%). Endocrinologists were identified as the primary prescribers for adolescents, followed by nurse practitioners and family medicine providers. In contrast, nurse practitioners were the most common prescribers for young adults, followed closely by family medicine providers and endocrinologists.
Given the shortage of endocrinologists and obesity medicine specialists, primary care physicians are likely to play a crucial role in the safe and appropriate prescribing of GLP-1 receptor agonists. Efforts should be made to provide education and training to these healthcare professionals to ensure the responsible use of these medications. Additionally, there is a growing need for more information on the long-term side effects and effectiveness of GLP-1 agonists, especially as they become more prevalent in younger patient populations. Lee emphasized the importance of considering the additional risks for young individuals of reproductive age when prescribing these medications.
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