Aim: Recent pediatric guidelines emphasize the need for aggressive treatment of childhood obesity, including use of recently approved pediatric weight loss medications like glucagon-like peptide receptor agonists (GLP1-RA), in order to preserve health. Given additional health risks related to T1D, we sought to assess practice patterns of obesity pharmacotherapy in a clinic sample of adolescents with T1D.
Methods: We extracted electronic health record (EHR) data from 12/1/17-12/1/23 of obese (BMI ≥95th %ile) youth with T1D aged 12 to <18 years prescribed ≥1 of FDA-approved pediatric weight loss (liraglutide, semaglutide, topiramate/phentermine, and orlistat) and type 2 diabetes (metformin and dulaglutide) medications.
Results: From 6 years of clinical observations, there were 540 unique adolescents with T1D aged 12-<18 years. Of these, 124 (23%) were obese. We identified 41 adolescents (63% female) with obesity prescribed ≥1 of the listed medications. Mean age at medication initiation was 14.6±2.2 years, and 46% saw a registered dietitian within a year before medication initiation. Metformin alone was prescribed for 33 youth and GLP1-RA for 8 adolescents (2 started directly on GLP1-RA; remaining 6 prescribed metformin first). All GLP1-RA were started after 2020 FDA approval for pediatric obesity treatment. No adolescents were prescribed topiramate/phentermine or orlistat. Of those with complete BMI data, those on metformin alone (29/33) had stable mean BMI percentile at up to 1 year follow-up, while those on GLP1-RA (6/8) experienced a small reduction in mean BMI percentile.
Conclusion: In this clinic sample, nearly 1 in 4 adolescents with T1D were obese. Despite recent FDA approval of new weight loss medications for children and adolescents, few were prescribed GLP1-RA. Further research is needed to understand patient/family and provider perspectives on these medications and their potential benefits for young people with T1D.
J. Doolan: None. E.M. Isganaitis: Research Support; Dexcom, Inc., Tandem Diabetes Care, Inc., Insulet Corporation, MannKind Corporation. L.M. Laffel: Consultant; Dexcom, Inc. Advisory Panel; Medscape, Medtronic, Vertex Pharmaceuticals Incorporated. Consultant; Novo Nordisk. Advisory Panel; Lilly Diabetes, Provention Bio, Inc., Sanofi-Aventis U.S., Janssen Pharmaceuticals, Inc., MannKind Corporation. T.K. Maxwell: None.
