1 of 1

Efficacy of GLP1 Agonists on Glycemic Control in YOT2D

Jordan A. Bays¹, Jade V. Johnson¹, Shaida D. Kamali¹,  

and Jeanie B. Tryggestad¹ 

¹ Section of Diabetes/Endocrinology

Department of Pediatrics, and Harold Hamm Diabetes Center,

University of  Oklahoma Health Sciences Center 

​

​

Background and Purpose

​

Youth Onset Type 2 Diabetes (YOT2D) has risen sharply, with a 30.5% increase in prevalence between 2001 and 2009 and a 5% annual rise in incidence from 2002 to 2015, disproportionately affecting racial and ethnic minorities. Over two years, these factors have contributed to a 20% increase in new YOT2D cases at OU Health. Glucagon-like peptide-1 agonists (GLPs) are one treatment that can be used by enhancing insulin secretion, suppressing glucagon secretion, slowing gastric emptying and decreasing appetite. They act on glucagon-like peptide-1 receptors (GLP-Rs) on islet cells in the pancreas. GLPs were approved for pediatric use in 2019. This study focuses on pediatric patients with YOT2D that were prescribed a GLP to determine the difference between hemoglobin A1C, weight and BMI before and after treatment was started. 

​

​

​

Study Design

Participants: 

This retrospective study analyzed data from the electronic medical records (EMR) and internal documentation of 80 pediatric patients (<21 years) diagnosed with type 2 diabetes (T2D) and receiving care at OU Health Children’s Hospital within the study period (1/1/2015 – 6/1/2024). Inclusion criteria are based on ADA diagnostic standards for T2D, including BMI >85th percentile for age and sex at diagnosis, absence of pancreatic autoantibodies (including antibodies to protein tyrosine phosphatase, glutamic acid decarboxylase, insulin and zinc transporter 8), and confirmation of hyperglycemia through fasting glucose >126 mg/dL, random glucose >200 mg/dL, or A1C >6.5% with symptoms. Patients included had a history of being prescribed a GLP medication, including Liraglutide, Dulaglutide and Semaglutide. The patients must have an appointment prior to the initial prescription and a follow-up appointment where they confirmed taking the medication. Patients with diagnoses other than T2D, over the age of 21 and who failed to follow-up after beginning the medication are excluded.

​

​

​

​

​

Results

Protocol: 

Hemoglobin A1C levels, weight (in kilograms) and BMI were obtained at the appointment prior to and the first follow-up after beginning the GLP1 agonist. The data was de-identified with a separate key and recorded in an electronic spreadsheet for analysis. The mean value before and after were calculated with a standard deviation for each of the variables of interest. The before and after data sets were compared using a paired two-way t-test with a calculated p-value for each analysis to determine statistical significance.  

After an average of 4.5 months of initiating GLP-1 therapy in obese youth with T2D, A1c, BMI and weight significantly improved. Our clinical findings are in line with previously published multi-center trials. Two of the main GLP1 agonists prescribed to the population, Dulaglutide and Liraglutide, are reported to decrease A1Cs in 26-52 weeks. Currently approved GLP-1 agonist have varying efficacy for glucose control and weight loss. Semaglutide and Dulaglutide have been shown to have greater effects on A1C, but many of the patients in our population started on Liraglutide. A future study to consider would focus on comparing the three main GLP1 agonists to determine the efficacy of each.  

Conclusions

Hemoglobin A1C Before and After Starting a GLP

p-value < .01

p-value < .05

Weight Before and After Starting a GLP

BMI Before and After Starting a GLP

p-value < .01

Patient Demographics