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

Megan O. Bensignor, MD

New findings suggest adolescent patients with type 2 diabetes (T2D) prescribed a glucagon like peptide-1 receptor agonist (GLP-1 RA) within 1 year of diagnosis were more likely to be in better glycemic control and less probable to be prescribed insulin than those prescribed after 1 year of diagnosis.

The study investigators noted factors other than HbA1c or age, including comorbidities or medication adherence, may have directly influenced prescribing rates in this patient population.

“This differs from findings in adults in which predictors of any therapy 1 year after T2D diagnosis include younger age and poor baseline glycaemic control,” wrote study author Megan O. Bensignor, MD, Center for Pediatric Obesity Medicine, Department of Pediatrics, University of Minnesota.

The objective of the current chart review aimed to explore prescribing practices of GLP-1 RAs, as little is known in adolescents with T2D. An electronic health record was thus searched for all patients aged 10 -20 years from January 2018 - August 2020 with a diagnosis of T2D after 2015, measured by an HbA1c of ≥6.5% and no diabetes autoantibodies.

Investigators reviewed data from date of diagnosis to August 2021, in order to confirm all patients had T2D and all data at least 1 year following diagnosis were included as well. At diagnosis, sex, race, and ethnicity were obtained and body mass index (BMI) and HbA1c were recorded. Moreover, date and the type of first GLP-1 RA prescribed were obtained, as were concomitant anti-obesity and anti-diabetes medication status.

Data show the most frequently prescribed GLP-1 RA was liraglutide (n = 32; 59.3% of prescriptions), while 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 investigators further noted the majority of prescriptions (n = 35; 64.8%) were prescribed off-label for adolescents. Among all prescribed GLP-1 RAs, 66.7% (n = 36) were also prescribed long-acting insulin with a mean dose of 0.42 ± 0.32 units/kg/d.

Data additionally show at the time of diagnosis, these patients had a mean age of 14.0 ± 2.1 years and a mean BMI of 37.0 ± 7.8 kg/m². A total of 28 patients (28.0%) were prescribed a GLP-1 RA within 1 year of diagnosis, with no significant differences observed in any characteristics between those prescribed versus those not within 1 year of diagnosis.

Altogether, 54 patients (54.0%) were prescribed a GLP-1 RA from January 2015 - August 2021, according to investigators. The mean age was 14.8 ± 1.9 years with a mean BMI of 37.9 ± 7.7 kg/m². Investigators found the mean HbA1c at time of prescription was lower in those prescribed within 1 year of diagnosis versus those prescribed 1 year after diagnosis (8.5% ± 2.4% vs. 10.3% ± 2.8%; P = .014).

Patients prescribed within 1 year of diagnosis were less likely to be prescribed concomitant insulin therapy than patients who were prescribed a GLP-1 RA after 1 year since their diagnosis (53.6% vs 80.8%; P = .039), according to investigators.

“As more GLP-1 RAs become FDA approved, an area of additional research should be to evaluate how prescribing patterns change over time with increasing access to these medications,” Bensignor concluded.

The study, “Glucagon-like peptide-1 receptor agonist prescribing patterns in adolescents with type 2 diabetes,” was published in Diabetes, Obesity, and Metabolism.