Off-label prescribing of metformin was commonly seen among U.S. adolescents aged 10–19 years, based on a study published in the Journal of Clinical Pharmacy and Therapeutics., a biguanide antihyperglycemic, is the only approved agent for use in adolescents with type 2 diabetes mellitus (T2DM). Its use in other conditions such as obesity, hyperinsulinemia, prediabetes, and metabolic syndrome of polycystic ovarian syndrome have also been reported.

To assess patterns of metformin prescribing for both on-label and off-label uses in adolescents, scientists from Merck & Co. Inc., analyzed data from the National Disease and Therapeutic Index (NDTI) database, the MarketScan® Commercial Claims and Encounters database, and the Multi-State Medicaid database. They identified the proportion of diagnoses associated with metformin that was recommended during a clinical visit in the NDTI database. The other databases were utilized to extract data on adolescents with ≥1 metformin prescription with 6 months continuous enrollment from the date of the index metformin prescription.

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According to the NDTI database, the most common diagnoses for metformin use were diabetes (34.9%), metabolic syndrome (20.9%), PCOS (17.2%), and obesity (6.5%). According to the MarketScan commercial database, T2DM was the most common diagnosis for girls aged 10–14 years (22.8–23.6%), boys aged 10–14 years (20.5–24.5%), and boys aged 15–19 years (37.1–43.1%). PCOS was the most common diagnosis for girls aged 15–19 years (24.1–28.3%). 

According to the Medicaid database, T2DM was the most common diagnosis among all 4 groups, reporting higher proportions than their counterparts in the Commercial database. 

Study authors were able to conclude that off-label prescribing for metformin was common among the studied population. However, to avoid possible overestimation, they noted caution with using metformin prescriptions as an estimate of the T2DM burden among adolescents.  

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