Earlier initiation of GLP-1 RAs Linked to Better Glycemic Control in Adolescents with T2D

Type 2 diabetes (T2D) in youth is a more aggressive disease that is associated with earlier co-morbidities compared with T2D in adulthood. Treatment guidelines for paediatric T2D first recommend lifestyle management and metformin, which rarely achieve meaningful body mass index (BMI) reduction.

The electronic health record (EHR) of a large medical centre was queried for all patients, aged 10-20 years, billed for T2D from January 2018 to August 2020 with a diagnosis of T2D after 2015. Patients were included if they had been diagnosed with T2D by a HbA1c measurement of 6.5% or higher and did not have diabetes autoantibodies. Each participant's EHR was reviewed from date of diagnosis to August 2021 to ensure that all patients had T2D, and all data at least 1 year postdiagnosis were included. This study was approved by the institution's Institutional Review Board.

The results are:

The most frequently prescribed GLP-1RA was liraglutide (n = 32; 59.3% of prescriptions); 46.9% (n = 15) prescriptions were written prior to FDA approval of liraglutide for youth with T2D. Semaglutide subcutaneous was prescribed for 13 patients (24.1%), followed by exenatide ER (n = 4; 7.4%), exenatide twice-daily (n = 2; 3.7%), deglutide (n = 2; 3.7%), and semaglutide oral (n = 1; 1.8%). The majority of GLP-1RA prescriptions (n = 35; 64.8%) were prescribed 'off-label'; either for patients prescribed liraglutide or exenatide ER prior to approval or another GLP-1RA prescribed for patients younger than 18 years. Among all patients prescribed GLP-1RAs, 66.7% (n = 36) were also prescribed long-acting insulin with a mean dose of 0.42 ± 0.32 units/kg/d. Sixteen patients (29.6%) prescribed GLP-1RAs were prescribed metformin without insulin, and 64.4% (n = 29) were prescribed both metformin and insulin.

Thus, this retrospective chart review described GLP-1RA prescribing patterns for adolescents with T2D and predominantly severe obesity (BMI > 1.2 × 95th percentile). Interestingly, patients who were prescribed a GLP-1RA within 1 year of T2D diagnosis were more probable to be in better glycaemic control and less probable to also be prescribed insulin than those who were prescribed a GLP-1RA after 1 year since their diagnosis.

Reference:

Glucagon-like peptide-1 receptor agonist prescribing patterns in adolescents with type 2 diabetes by Megan O. Bensignor et al. published in the Diabetes, Obesity, and Metabolism.

https://dom-pubs.onlinelibrary.wiley.com/doi/full/10.1111/dom.14681