Department of Paediatrics, University of Cambridge, Cambridge, UK.
MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge, Cambridge, UK.
Obes Rev. 2021 Jun;22(6):e13177. doi: 10.1111/obr.13177. Epub 2020 Dec 22.
Pharmacological options for management of obesity and type 2 diabetes mellitus (T2DM) in children are limited. We aimed to synthesize published randomized controlled trial (RCT) evidence on the efficacy of glucagon-like peptide-1 (GLP-1) agonists in T2DM, pre-diabetes, and obesity in children aged <18 years. Inclusion criteria were RCTs of any GLP-1 agonist, solely or in conjunction with other drugs, for the treatment of obesity, pre-diabetes, and/or T2DM in children aged <18 years old. Nine studies met the inclusion criteria (two for T2DM, one for pre-diabetes, and six for obesity without diabetes). In total, 286 children were allocated to GLP-1 agonist therapy. Compared with controls, GLP-1 agonist therapy reduced HbA1c by -0.30% (95% confidence interval [CI] -0.57, -0.04) with a larger effect in children with (pre-)diabetes (-0.72%; 95% CI -1.17, -0.28; three studies) than in children with obesity (-0.08%; 95% CI -0.13, -0.02; four studies). Conversely, GLP-1 agonist therapy reduced body weight more in children with obesity (-2.74 kg; 95% CI -3.77, -1.70; six studies) than in children with T2DM (-0.97 kg; 95% CI -2.01, 0.08; two studies). Adverse effects included gastrointestinal symptoms and minor hypoglycemic episodes, but not severe hypoglycemia. GLP-1 agonists are efficacious in treating children with obesity and/or T2DM. Effect sizes are comparable with those reported in adults.
儿童肥胖和 2 型糖尿病（T2DM）的治疗药物选择有限。本研究旨在综合已发表的随机对照试验（RCT）证据，评估胰高血糖素样肽-1（GLP-1）激动剂治疗儿童 T2DM、糖尿病前期和肥胖的疗效。纳入标准为：任何 GLP-1 激动剂治疗儿童（年龄<18 岁）肥胖、糖尿病前期和/或 T2DM 的 RCT，药物单独或联合其他药物使用。共 9 项研究符合纳入标准（2 项 T2DM、1 项糖尿病前期、6 项无糖尿病肥胖），共纳入 286 名儿童。与对照组相比，GLP-1 激动剂治疗可使 HbA1c 降低 0.30%（95%置信区间[CI] -0.57，-0.04），在糖尿病前期（-0.72%；95%CI -1.17，-0.28；3 项研究）儿童中的疗效大于肥胖（-0.08%；95%CI -0.13，-0.02；4 项研究）儿童。相反，GLP-1 激动剂治疗在肥胖儿童（-2.74kg；95%CI -3.77，-1.70；6 项研究）中降低体重的效果大于 T2DM 儿童（-0.97kg；95%CI -2.01，0.08；2 项研究）。不良反应包括胃肠道症状和轻微低血糖事件，但无严重低血糖。GLP-1 激动剂在治疗肥胖和/或 T2DM 儿童方面是有效的。疗效与成人报道的结果相当。
