Background: Despite the high risk of diabetes complications at an early age in youth with type 2 diabetes (T2D), there are limited pharmacologic options to manage T2D in youth. The first Glucagon-like-peptide-1 agonist (GLP-1a) was approved for pediatric T2D treatment in 2019. However, little is known on the real-world use and effectiveness of GLP-1a for management of T2D in the pediatric population.

Objectives: To assess the real-world use and effectiveness of GLP-1a (exenatide, dulaglutide, liraglutide, semaglutide) in managing T2D in a diverse cohort of youth. Methods: This multicenter retrospective analysis included adolescents and young adults (ages 11-25y) from two academic pediatric diabetes centers who were prescribed a GLP-1a for management of T2D. Patient HbA1c, weight, and BMI within 12 months of follow-up after GLP-1a prescription were compared to baseline using Signed Rank tests. Secondary outcomes included insulin and metformin use after GLP-1a initiation and were compared using McNemar's test.

Results: A total of 153 patients (median age 16.1 years (IQR 13.9-17.8), 57% female, 59% non-Hispanic Black, 23% Hispanic or Latino, 76% with public insurance) were prescribed GLP-1a and 36 patients discontinued the GLP-1a. At a median follow-up of 8.2 months, 117 patients were taking GLP-1a and were included in pre-post analyses. From baseline to follow-up, HbA1c decreased from 8.3% to 7.5% (p<0.007), while weight and BMI remained stable. At baseline, 48% of patients were taking prandial insulin, compared to 36% at follow-up (p=0.001), 71% were taking basal insulin compared to 62% at follow-up (p = 0.025), and 85% were prescribed metformin at baseline compared to 74% at follow-up (p=0.005).

Conclusion: Real-world use of GLP-1a in youth with T2D is associated with decreased HbA1c levels. GLP-1a treatment may reduce doses of insulin and other medications for diabetes in youth, which can mitigate the burden of daily diabetes management.

Disclosure

S.Samuels: None. A.Chajecki: None. P.Hu: None. M.Kayser: None. K.Weyman: None. B.Pan: None. E.A.Brown: None. M.A.Van name: Research Support; Provention Bio, Inc. R.M.Wolf: Research Support; Dexcom, Inc., Boehringer Ingelheim Inc.

Funding

American Diabetes Association (7-22-JDFN-03 to S.S.); National Institutes of Health (R01DK134955)

© 2023 by the American Diabetes Association
2023
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