New research being presented at the annual meeting of the European Association for the Study of Diabetes (EASD) in Milan, Italy (Sept 28 – Oct 2) has examined the real-world use of GLP-1 receptor agonist (GLP-1 RA) drugs in children and young people in Germany, Austria and Luxembourg.
European regulators approved GLP-1 RAs to treat type 2 diabetes (T2D) in children from the age of ten in 2019. Approval for weight management in children with obesity aged 12 and over followed in 2021 and the indication has since been extended to include children age six and above.
However, little is known about how the drugs, which include semaglutide (trade names Ozempic and Wegovy), liraglutide (brand names Victoza and Saxenda), dulaglutide (Trulicity) and tirzepatide (Mounjaro), are used in this population.
Dr Marie Auzanneau of Ulm University, Ulm, Germany, who led the research, says: "Around 200,000 young people in Germany are living with extreme obesity and they are often affected by severe obesity-related complications such as sleep apnoea, depression and type 2 diabetes.
"GLP-1 receptor agonists specifically target the biological mechanisms of extreme obesity and can be particularly beneficial for adolescents who previously had a continuous and significant weight gain, despite lifestyle interventions like diet and exercise programmes.
"It is therefore important to know how often they are being prescribed."
To find out more, Dr Auzanneau and colleagues in Germany, Austria and Luxembourg first looked at how use of these drugs has changed over time.
They did this by analysing information on all 1,878 individuals aged 6-24 years with T2D (median age: 16.3 years, 54% female, 37% with migration background) included in the Diabetes Prospective Follow-up (DPV) registry, a multi-country initiative designed to track the health and improve the treatment of people with diabetes, between 2019 and 2025.
They found that 388 of the 1,878 children and young people had taken GLP-1 RAs (including GIP/GLP-1 RAs i.e. tirzepatide) during that time and that growing numbers were using them (up from 6.3% of the 448 children and young people with T2D in the registry in 2019 to 27.2% of the 611 with T2D in 2025).
Use increased in all age groups and, in 2025, the drugs were prescribed to 14% of the children T2D aged 6-<12 years, 28% of those aged 12-<18, and 29% of those 18-24 years (figure 3 of abstract).
"GLP-1 receptor agonists are probably still underused in children adolescents and young people," says Dr Auzanneau. "This is to be expected because these treatments are relatively new for these age groups. There may be concerns about side-effects and there may be issues regarding health insurance cover. We expect use to continue to increase as these issues are addressed."
Liraglutide was the most frequently prescribed and, in 2025, it was used by 11.8% of all young people with T2D (n=611), corresponding to 72 of the 166 (43.4%) of those taking GLP-1 RAs that year (figure 2 of abstract).
The study's authors then looked at whether use of GLP-1 RAs was associated with changes in BMI, blood pressure and glycaemic (blood sugar) control.
"We were interested in this because while these drugs have performed very well when given to young people under the tightly controlled conditions of clinical trials, data on concrete benefits in real-world conditions is lacking," explains Dr Auzanneau.
This analysis focused on a subset of 240 children and young people (median age: 16.4 years, 59% female, 47% with migration background) who had a use of GLP-1 RA documented in the DPV database during at least two visits to the treatment centre. GLP-1 RA treatment started on visit 1.
Median duration of GLP-1 RA use was 11 months. Liraglutide was the main GLP-1 RA used, followed by dulaglutide, semaglutide and tirzepatide (70% 15%, 10% and 4%, respectively, at first visit, and 63%,17%, 17% and 8% at last visit). GLP-1 RAs were typically used alongside other treatments, most commonly metformin.
Some 19% of the children and young people were living with overweight when they started GLP-1 RA therapy, 44% were living with obesity and 32% with extreme obesity.
As children and teenagers are still growing, their BMI is expressed relative to others of the same age. One measure of this is BMI SDS, where a higher score indicates a higher weight. Average BMI SDS was 2.23, which is in the obese range.
More than a third (37%) of the young people achieved a reduction of ≥ 5% in their BMI SDS and 25% achieved a reduction of at least 10%. The average reduction overall was 2.3%.
"A reduction of 2.3% is meaningful when we consider that many of these children and young people had gained weight for years, despite making lifestyle changes," says Dr Auzanneau.
Glycaemic control (measured via HbA1c test) improved and the proportion of children and young people with hypertension decreased from 60% to 52%.
Statistically significant reductions in BMI SDS and systolic blood pressure and improvements in glycaemic control remained after adjustment for sex, age group, migration background and BMI on starting therapy.
The study's authors conclude that real-world data from three European countries shows that the use of GLP-1 RAs is fast increasing in children, adolescents and young adults – with significant health benefits.
Dr Auzanneau says: "Our results confirm that GLP-1 receptor agonists have real benefits for children, adolescents and young adults with type 2 diabetes, many of them will have gained weight for years, despite making changes to their lifestyle.
"This isn't just about weight loss. By helping children, adolescents and young adults reach a healthier weight, these drugs should reduce their likelihood of developing depression, sleep apnoea and other severe conditions that are linked to obesity.
"Moreover, by helping these young people achieve better glycaemic control, the GLP-1 receptor agonists will help lower the risk of heart disease and damage to the eyes, kidneys and nerves. This is very important because these complications of type 2 diabetes reduce the quality and, often, also the length of life."
