Glucagon-like Peptide-1 Receptor Agonists for the Treatment of Type 2 Diabetes in Youth

Abstract

Glucagon-like peptide-1 receptor agonists (GLP-1RAs) have gained traction for the management of type 2 diabetes and obesity. Unlike several classes of antidiabetic medications that contribute to weight gain, GLP-1RAs not only reduce haemoglobin A1c, but also promote weight loss. While there is a large body of evidence supporting its safety and efficacy in adults, paediatric clinical trial data have only emerged in recent years. This review will discuss the limited treatment options for paediatric type 2 diabetes and the mechanism of action of GLP-1RAs as it pertains to physiological pathways relevant for type 2 diabetes, obesity and their related comorbidities. The outcomes of paediatric trials evaluating liraglutide, exenatide, semaglutide and dulaglutide in paediatric type 2 diabetes and obesity will be closely examined, including differences compared with adult studies. Finally, potential barriers and strategies to expanding GLP-1RA access in adolescents will be discussed. Future studies are needed to determine if the cardio- and renal-protective benefits of GLP-1RAs apply to youth-onset type 2 diabetes.

Glucagon-like Peptide-1 Receptor Agonists—A Potential New Medication for Pediatric Metabolic-Dysfunction-Associated Steatotic Liver Disease (MASLD)

“…Liraglutide was the first GLP-1 RA approved for use of the treatment of pediatric T2DM by the FDA in 2019 [ 22 ]. Since then, several other GLP-1 RAs have been approved for pediatric use, including dulaglutide and exenatide [ 23 ]. Liraglutide and semaglutide are additionally approved for use as adjunctive therapy for weight loss in the pediatric population.…”

Commentary on "Effects of once-weekly dulaglutide on juvenile type 2 diabetes mellitus and obesity in Korea: a pilot study"

“…Despite many new drugs for the treatment of adult T2DM, medication for juvenile T2DM has been limited to metformin in most countries and sulfonylurea in some, and there are only five agents approved by the U.S. Food and Drug Administration for children and adolescents with T2DM [ 7 , 8 ]. In the guidelines of the International Society for Pediatric and Adolescent Diabetes, American Diabetes Association, and European Association for the Study of Diabetes, the initial therapy for youth-onset T2DM is oral metformin with healthy lifestyle changes.…”