OBJECTIVES: To assess adherence and persistence to OAD medications in the pediatric population and to determine how adherence and persistence differ by age, gender and race in the study population. METHODS: A retrospective cohort analysis of the Texas Medicaid prescription claims database. The study included pediatric subjects (10-18 years) with type 2 diabetes who had OAD medications between January 2006 and December 2009. Index date was defined as the date subjects had their first OAD medication between January 1, 2006 and December 31, 2009. Prescription claims were analyzed over a 6 month pre-index period through a 12-month post-index period. Adherence was measured using the medication possession ratio (MPR). RESULTS: A total of 3,109 subjects met inclusion criteria. The overall mean MPR± SD was 44.69% ± 27.06. Adherence differed by gender (p<0.0001); race (p<0.0001); and age category (p<0.0001). Males had higher mean MPR± SD (47.47 ± 27.42) compared to females (43.29 ± 26.78). In addition, mean MPR for whites (50.04 ± 29.65) was significantly higher compared to blacks (44.24 ± 26.16) and Hispanics (42.50 ± 26.10).  Subjects ≤ 12 years of age had significantly higher mean MPR (48.82 ± 27.27) compared to those in older age categories.  Logistic regression analysis revealed that age (continuous) was significantly related (OR=0.91; 95% CI=0.87-0.95) to being adherent (MPR≥80%).  Males were 25% (OR= 1.25; 95%CI=1.02-1.53; p=0.034) more likely to be adherent (MPR≥80%) compared to females and whites were twice more likely to be adherent (MPR≥80%) compared to Hispanics (OR=2.02; 95%CI=1.54-2.66; p=0.0012). The overall mean days to non-persistence (± SD) was 108 days (± 86). Persistence was significantly and negatively associated with age (p <0.0001). Among the covariates, white race was significantly related to longer persistence. CONCLUSIONS: Adherence and persistence to OAD medications in the study population is generally suboptimal.