Background:
Rates of pediatric obesity and adolescent type 2 diabetes mellitus (T2DM) continue to rise, with obesity affecting approximately 19% of children aged 5–14 years in recent estimates and T2DM prevalence increasing to 0.67 per 1,000 youths. Modeling projections suggest that up to 57% of children aged 2–17 years may develop obesity by adulthood, and the prevalence of youth-onset T2DM could increase by more than sixfold by 2060. Current clinical guidelines emphasize early intervention, with professional societies discouraging watchful waiting and recommending prompt, multifactorial treatment.
Methods: We conducted a narrative review of PubMed and MEDLINE to identify randomized controlled trials, meta-analyses, and observational studies evaluating glucagon-like peptide-1 receptor agonist (GLP-1 RA) use in pediatric populations (≤18 years) for obesity and T2DM.
Results: Lifestyle modification remains the foundation of management of pediatric obesity and T2DM, but is associated with modest reductions in body mass index and variable effectiveness in adolescents. Pharmacotherapy and metabolic surgery are increasingly incorporated for select patients. GLP-1 RAs, initially approved for T2DM based on glucose-dependent insulin secretion and glucagon suppression, exert pleiotropic effects including central appetite regulation, delayed gastric emptying, weight reduction, and cardiometabolic risk modification. In pediatric populations, meta-analyses demonstrate statistically significant improvements in body weight, BMI, BMI z-score, hemoglobin A1c, and systolic blood pressure, with gastrointestinal adverse effects being the most commonly reported side effects. However, most studies are of limited duration and do not systematically assess developmental outcomes.
Conclusions: Pediatric patients constitute a physiologically distinct population undergoing active linear growth, pubertal development, and neuroendocrine maturation, which limits direct extrapolation of adult GLP-1 RA data. While current evidence supports short-term efficacy and acceptable safety in select pediatric patients, significant gaps remain regarding long-term developmental effects, optimal dosing strategies, and durability of benefit. A measured and cautious expansion of GLP-1 RA use, emphasizing shared decision-making and longitudinal monitoring, is warranted while pediatric-specific evidence continues to evolve.
Methods: We conducted a narrative review of PubMed and MEDLINE to identify randomized controlled trials, meta-analyses, and observational studies evaluating glucagon-like peptide-1 receptor agonist (GLP-1 RA) use in pediatric populations (≤18 years) for obesity and T2DM.
Results: Lifestyle modification remains the foundation of management of pediatric obesity and T2DM, but is associated with modest reductions in body mass index and variable effectiveness in adolescents. Pharmacotherapy and metabolic surgery are increasingly incorporated for select patients. GLP-1 RAs, initially approved for T2DM based on glucose-dependent insulin secretion and glucagon suppression, exert pleiotropic effects including central appetite regulation, delayed gastric emptying, weight reduction, and cardiometabolic risk modification. In pediatric populations, meta-analyses demonstrate statistically significant improvements in body weight, BMI, BMI z-score, hemoglobin A1c, and systolic blood pressure, with gastrointestinal adverse effects being the most commonly reported side effects. However, most studies are of limited duration and do not systematically assess developmental outcomes.
Conclusions: Pediatric patients constitute a physiologically distinct population undergoing active linear growth, pubertal development, and neuroendocrine maturation, which limits direct extrapolation of adult GLP-1 RA data. While current evidence supports short-term efficacy and acceptable safety in select pediatric patients, significant gaps remain regarding long-term developmental effects, optimal dosing strategies, and durability of benefit. A measured and cautious expansion of GLP-1 RA use, emphasizing shared decision-making and longitudinal monitoring, is warranted while pediatric-specific evidence continues to evolve.