Glp-1 Drugs Beat Metformin For Weight Control In Teens With Type 2 Diabetes

A caller real-world study reveals that precocious GLP-1 therapies, including semaglutide and tirzepatide, supply comparable glycemic power while offering superior weight benefits compared to metformin successful adolescents recently diagnosed pinch type 2 diabetes.

Exploratory real-world acquisition pinch GLP-1 receptor agonists vs. metformin successful younker pinch new-onset type 2 diabetes: a single-center retrospective study. Image Credit: Meteoritka / Shutterstock

In a caller study published successful the Journal of Pediatric Endocrinology and Metabolism, researchers compared the efficacy of metformin and GLP-1–based therapies, including GLP-1 receptor agonists and nan dual GIP/GLP-1 agonist tirzepatide, successful younker recently diagnosed pinch type 2 diabetes (T2D).

Aggressive Nature and Treatment Challenges of Youth-Onset T2D

Youth-onset T2D progresses rapidly, pinch early onset of complications successful adulthood. Metformin remains nan first-line therapy for recently diagnosed pediatric patients; however, while it efficaciously lowers glycated hemoglobin (HbA1c), it has minimal effects connected weight nonaccomplishment and constricted durability successful glycemic control. GLP-1–based therapies, already recommended successful adults, are gaining traction successful younger populations owed to their glucose-lowering and weight-reducing effects.

Rationale for Exploring High-Potency GLP-1 Therapies

Several GLP-1 receptor agonists are approved for pediatric T2D, supported by guidelines arsenic adjunctive treatments to metformin. Yet, approved pediatric doses output humble weight benefits. This has prompted investigation into higher-potency GLP-1RAs and monotherapy approaches, including dual incretin agents specified arsenic tirzepatide, to measure whether stronger metabolic effects tin beryllium achieved successful this property group.

Study Design and Population Characteristics

This retrospective, real-world study extracted information from physics aesculapian records of an municipality pediatric hospital. Eligible participants were younker pinch recently diagnosed T2D who received GLP-1RA aliases metformin monotherapy betwixt January 2022 and March 2024. Exclusion criteria included operation therapy, insulin arsenic first-line treatment, and glucosuria secondary to different causes.

Collected variables included demographics, glucosuria duration, BMI, HbA1c, BMI z-scores, medicine type and dose, and adverse effects. All participants were publically insured. The superior outcomes were monthly changes successful HbA1c and percent BMI wrong nan first twelvemonth post-diagnosis, pinch secondary outcomes assessing median changes successful HbA1c, BMI, and z-scores.

Baseline Demographics and Medication Profiles

A full of 125 younker were included (median property 14.83 years), pinch 113 connected metformin and 12 connected GLP-1RA therapy. The GLP-1RA group was predominantly female (83%) compared to 51% successful nan metformin group, and less individuals identified arsenic Latino (41.7% vs 69.9%). The astir prescribed GLP-1RA was semaglutide 1 mg (33%), followed by tirzepatide 7.5 mg (25%). Higher-potency formulations (semaglutide up to 2.4 mg and tirzepatide) were used, which whitethorn relationship for stronger weight effects compared to pediatric tests that employed little doses. Seven GLP-1RA recipients reported gastrointestinal adverse effects specified arsenic nausea, vomiting, and constipation.

Comparative Glycemic and Anthropometric Outcomes

Baseline HbA1c levels were akin crossed groups. At follow-up, unadjusted analyses showed little HbA1c successful nan GLP-1RA group (36 vs 44 mmol/mol, p = 0.03), but adjusted models revealed nary statistically important monthly HbA1c alteration (β −1.1, p = 0.308). Median HbA1c decreased by 8.7 mmol/mol pinch metformin and 14.2 mmol/mol pinch GLP-1RA therapy.

Regarding weight outcomes, GLP-1RA recipients exhibited greater BMI simplification (−0.43 kg/m² per month) compared pinch metformin (−0.01 kg/m² per month). Adjusted regression study indicated an astir 1% further monthly BMI simplification pinch GLP-1 therapy (β = −1.08%, p = 0.001). Final percent BMI simplification was −5.1% for GLP-1RA and −0.59% for metformin, pinch corresponding z-score decreases of −0.02 and −0.01, respectively.

Interpretation of Efficacy and Safety Findings

At study completion, 83% of GLP-1RA users and 67% of metformin users achieved nan target HbA1c of 48 mmol/mol. Although glycemic power was comparable, GLP-1RA therapy conferred superior weight simplification benefits. Adverse events were constricted to gastrointestinal symptoms, accordant pinch nan known pharmacological effects of GLP-1. The mini sample size of nan GLP-1RA, however, limits generalizability, and baseline BMI differences whitethorn person influenced nan observed outcomes.

Study Limitations and Future Research Directions

The mentation of nan findings is constricted by nan mini GLP-1RA cohort (n = 12), baseline imbalances successful BMI and sex, nan single-center retrospective design, incomplete autoantibody testing, and a median follow-up of astir 8 months. Larger, multicenter tests pinch balanced cohorts and extended follow-up are required to corroborate comparative effects connected HbA1c sustainability, beta-cell preservation, and insulin sensitivity.