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Efficacy and Safety of GLP-1 RAs in Children and Adolescents With Obesity or Type 2 Diabetes: A Systematic Review and

Pareeta Kotecha1,2, Wenxi Huang1,2, Ya-Yun Yeh1,2

  • 1Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville.

JAMA Pediatrics
|September 15, 2025
PubMed
Abstract

Insights

Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) effectively improve glycemic control and reduce weight in pediatric obesity and type 2 diabetes (T2D). Gastrointestinal adverse events were noted, but serious safety concerns like suicidal ideation were not significantly increased.

Area of Science:

  • Pediatric Endocrinology
  • Metabolic Disorders
  • Pharmacotherapy Research

Background:

  • Childhood obesity is a growing epidemic, increasing the risk for type 2 diabetes (T2D).
  • Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) represent a key pharmacotherapy for this population.
  • Comprehensive evaluation of GLP-1 RA efficacy and safety in pediatric patients is crucial.

Purpose of the Study:

  • To systematically assess the efficacy and safety of GLP-1 RAs in children and adolescents (<18 years).
  • To evaluate GLP-1 RA use in pediatric populations with obesity, prediabetes, or T2D.
  • To synthesize evidence from randomized clinical trials (RCTs) on GLP-1 RA treatment outcomes.

Main Methods:

  • Systematic literature search of PubMed, Embase, and CENTRAL for RCTs up to February 28, 2025.
  • Inclusion of RCTs comparing GLP-1 RAs to placebo in pediatric patients with obesity, overweight, prediabetes, or T2D.
  • Data extraction on efficacy (HbA1c, glucose, weight, BMI, lipids, blood pressure) and safety (adverse events) with risk of bias assessment.

Main Results:

  • Eighteen RCTs with 1402 participants (838 GLP-1 RA users) were included.
  • GLP-1 RAs significantly reduced HbA1c, fasting glucose, body weight, BMI, BMI SDS, BMI percentile, and systolic blood pressure.
  • Increased gastrointestinal adverse events (GI AEs) were observed; suicidal ideation or behaviors did not differ significantly.

Conclusions:

  • GLP-1 RAs demonstrate significant efficacy in improving glycemic, weight, and cardiometabolic parameters in pediatric obesity and T2D.
  • While GI AEs require monitoring, current data suggest no significant increase in suicidal ideation or behaviors.
  • GLP-1 RAs are a valuable therapeutic option for managing pediatric obesity and T2D, with careful attention to safety profiles.

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