P-249: The changing landscape of pediatric type 2 diabetes: high GLP-1 ra utilization in a tertiary cohort
F Veintemilla Burgos, A Espinosa Monteros, C De Almagro, A Carrillo Iregui, A GranadosAbstract
Introduction
Use of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) in youth with type 2 diabetes (T2D) has increased, but real-world pediatric data remain limited. Recent reports suggest utilization as high as 35%, while insulin remains more frequently used (49%).
Objectives
We aimed to describe clinical characteristics of adolescents with T2D and evaluate real-world use of pharmacologic therapies at our tertiary center.
Methods
In this retrospective cross-sectional study of 139 adolescents with T2D, data collected included demographics, hemoglobin A1c (HbA1c), and BMI and weight z-score. Patients were categorized into four mutually exclusive treatment groups: metformin only, insulin therapy, GLP-1 RA without insulin, and no pharmacologic therapy. Group differences were analyzed using nonparametric and categorical tests.
Results
Median age was 16 years (IQR 14.5,18); 54% were female, 51% were Hispanic, and 78% publicly insured. The median weight z-score was 2.38 (IQR 1.95, 2.73), BMI z-score 2.25 (IQR 1.93,2.58), and HbA1c 6.5% (IQR 5.8–9.2). Overall use was metformin (68%), insulin (41%) and GLP-1 RAs (62%), with Semaglutide being the most commonly used GLP-1 RA. In a mutually exclusive analysis, BMI z score was highest in GLP1 RA group (2.61) compared to the metformin, insulin and non-pharmacologic therapy (2.31 vs. 2.16 and 2.35, respectively, p 0.002). HbA1C differed across groups, 6.1% in metformin, 6% GLP1 RA, no pharmacologic therapy 6.2% and insulin 9.6% (p <0.001). No differences in medication use were observed by race/ethnicity or insurance.
Conclusions
GLP-1 RA use exceeded prior reports, indicating rapid uptake in pediatric T2D. Higher BMI z-scores in the GLP-1 RA group likely reflect targeted use in adolescents expected to benefit from weight reduction. Moreover, GLP-1 RA demonstrated better glycemic control. Together, these findings support GLP-1 RAs as an effective and increasingly central therapy in youth with T2D.