Endocrine Abstracts

Introduction: The use of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) in children and adolescents has emerged as a promising therapeutic strategy for managing obesity and type 2 diabetes mellitus.

Methods: Data were collected retrospectively from patients’ records from Complication of Excess Weight Clinic (CEW), Paediatric Endocrine and Paediatric Diabetes Clinics at Oxford University Hospitals.

Results: Medical records of 28 patients (mean age 15.9±1.6 years, 50% females) were analysed. Most patients were treated for primary obesity and five for secondary obesity to hypothalamic dysfunction (3-craniopharyngioma, 1-neurofibromatosis and 1-Langerhans cell histiocytosis). At the time of analysis, the mean treatment duration was 11.6±6 months. The mean initial BMI z-score was 3.83±0.6, which decreased to 3.54±0.7. In those with hypothalamic obesity, initial mean weight was 100.6±14 kg, reducing to 94±12 kg at 3 months and 92±12 kg after an average 13 months of treatment (8.5% total weight loss). Among patients with primary obesity, the initial mean weight was 113.2±16 kg, decreasing to 104±19 kg at 6 months and 101.3±19 kg after 11.1±5 months, with a total weight loss of 10.6%. The median semaglutide dose at analysis was 1.7 mg/week. In patients without diabetes, mean HbA1c decreased from 38.7 to 33.5 mmol/mol. In all patients with prediabetes, HbA1c normalized, indicating reversal of prediabetes. Liver function tests also improved during treatment in 30% of patients and in 1 patient severe sleep apnoea requiring BiPAP has reversed. Two patients had difficulties with compliance, resulting in initial weight loss followed by regain. Both are currently undergoing dose re-escalation. One patient discontinued treatment due to nausea and vomiting. Overall, 10% of the cohort reported nausea, and one patient reported possible sleep disturbances.

Summary: Our preliminary data suggest that GLP-1RAs is an effective and well-tolerated treatment option for children and adolescents with obesity, including those with complex aetiologies such as hypothalamic obesity. Improvements in BMI, HbA1c, liver function with greater weight loss among those with primary obesity were observed. These findings support the role of GLP-1 RAs as part of a multidisciplinary approach to paediatric obesity management.