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GLP-1 receptor agonists improve BMI in pediatric obesity and HbA1c in youth-onset type 2 diabetes while maintaining an acceptable short-term safety profile.
As childhood obesity and youth-onset type 2 diabetes mellitus (T2DM) continue to rise worldwide, a new systematic review highlights glucagon-like peptide-1 receptor agonists (GLP-1 RAs) as promising options that extend beyond lifestyle modification and metformin. The analysis found that these agents improve weight, glycemic control, and several metabolic markers in children and adolescents, with mainly mild, transient gastrointestinal side effects.
The review examined 13 PubMed-indexed studies issued between 2000 and 2025, including seven pivotal randomized controlled trials and six meta-analyses, encompassing 901 participants aged 6 to <18 years with obesity or youth-onset T2DM. Among the therapies evaluated, semaglutide 2.4 mg once weekly delivered the greatest reduction in body mass index (BMI) in adolescents with obesity. Liraglutide 3.0 mg once daily also reduced BMI and improved BMI standard deviation score (BMI SDS) in both adolescents and younger children, illustrating benefits across pediatric age groups.
For children and adolescents with youth-onset T2DM, liraglutide 1.8 mg/day and dulaglutide improved glycated hemoglobin (HbA1c) compared with placebo, reinforcing their value as effective add-on therapies for glycemic care. Beyond weight loss and glucose control, GLP-1 RAs were associated with improved insulin resistance and modest reductions in triglyceride levels, although low-density lipoprotein (LDL) cholesterol changed little across studies.
The review also supports the favorable short-term safety of GLP-1 RAs in pediatric populations. The most commonly reported adverse events were nausea and vomiting, which were generally transient and dose-dependent. Importantly, investigators found no vital effects on linear growth or pubertal progression, addressing key concerns surrounding the usage of these therapies during childhood and adolescence.
According to the authors, this is the first study to comprehensively compare GLP-1 RAs across pediatric obesity and youth-onset T2DM, integrating potency on efficacy, metabolic effects, safety, and developmental outcomes, while directly contrasting pediatric findings with adult trial data. Despite these encouraging findings, the review emphasizes that important questions remain unanswered. The authors call for long-term studies to assess the impact of GLP-1 RAs on cardiovascular safety, bone health, growth, pubertal development, and other long-term outcomes, helping define their role in the long-term management of pediatric metabolic disease.
Diabetes Research and Clinical Practice
GLP-1 receptor agonists in pediatric obesity and diabetes: a systematic review of efficacy, metabolic effects, and safety
Ashraf T. Soliman et al.
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