Meta-analysis shows efficacy of GLP-1 agonists in children with T2DM, obesity

  • Chadda KR & al.
  • Obes Rev
  • 22 Dec 2020

  • curated by Sarfaroj Khan
  • UK Clinical Digest
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Takeaway

  • Glucagon-like peptide-1 (GLP-1) agonists are efficacious in treating children with obesity and type 2 diabetes mellitus (T2DM).
  • Effect sizes on glycated haemoglobin (HbA1c), fasting plasma glucose (FPG) and weight were comparable with those in adults.

Why this matters

  • Pharmacological options for management of obesity and T2DM in children are limited.
  • This is the first meta-analysis on the effects of GLP-1 agonists in children with T2DM or obesity.

Study design

  • Meta-analysis of 9 randomised trials (2 for T2DM; 1 for pre-diabetes; 6 for obesity without diabetes).
  • Across all studies, 286 children were allocated to GLP-1 agonist therapy.
  • Funding: Medical Research Council.

Key results

  • Meta-analysis of 7 studies revealed that GLP-1 agonists reduced HbA1c by −0.30% (95% CI, −0.57 to −0.04%; I2=93.9%) over a mean treatment duration of 18 weeks.
  • Meta-analysis of 9 studies showed an overall reduction of −3.99 mg/dL (95% CI, −7.13 to −0.86 mg/dL; I2=59.4%) in FPG with GLP-1 agonists over on average 18 weeks.
  • Children with pre-diabetes vs those with obesity showed a greater reduction in:
    • HbA1c (−0.72%; 95% CI, −1.17 to −0.28%; I2=67.4% vs −0.08%; 95% CI, 0.13 to −0.02%); and
    • FPG (−19.42 mg/dL; 95% CI, −37.49 to −1.36 mg/dL; I2=60.2% vs −1.87 mg/dL; 95% CI, −3.53 to −0.21 mg/dL).
  • Meta-analysis of 8 studies showed an overall reduction in weight of 1.86 kg (95% CI, −2.60 to −1.13 kg) over 19 weeks.
  • Children with obesity had more reduction in weight vs those with T2DM (−2.74 kg; 95% CI, −3.77 to −1.70 kg vs −0.97 kg; 95% CI, −2.01 to 0.08 kg).
  • Adverse effects included gastrointestinal symptoms and minor hypoglycaemic episodes, but not severe hypoglycaemia.

Limitations

  • Relatively small number of trials.
  • Heterogeneity among studies.