OBJECTIVES : Randomized Controlled Trials performed in children and adolescents conclude that short term metformin treatment appears to be well tolerated and moderately affects weight reduction associated with the use of atypical antipsychotics in severely obese children and adolescents. However, there are limited studies in this population describing the actual usage patterns and utilization from a real-world perspective.

METHODS : The study was a retrospective cohort study of diabetes naïve population of children and adolescents on atypical antipsychotics, using a nationally representative EMR database. Patients selected were≤ 21 years of age diagnosed with a metal health disorder using atypical or 2^nd generation antipsychotics between Jan 1, 2009 and Dec 31, 2018. Incidence of metformin usage patterns and descriptive characteristics of the cohort were examined

RESULTS : 140,559 patients were included in the analysis who had anytime usage of atypical antipsychotics between Jan 1, 2009 and December 31^st, 2018. Almost half of the patients were diabetes naïve (65,776). Finally analyzing the cohort of 65,776 patients ≤21 years of age, anytime usage of metformin after starting atypical antipsychotics was seen in 2,454 patients which corroborated to an incidence of 3.7% in this cohort. The cohort had almost equal distribution of males and females where majority of the patients were non-Hispanics (83%). In the final analyzed cohort, majority of the patients were whites (69%) followed by African Americans (16%).

CONCLUSIONS

We analyzed the metformin incidence and usage patterns in children and adolescents on atypical antipsychotics and found racial differences in the utilization. Future studies should focus on the various predictors and the differences in treatment patterns and metformin usage in this population.