Ann Pediatr Endocrinol Metab.  2023 Dec;28(4):296-301. 10.6065/apem.2244196.098.

Effects of once-weekly dulaglutide on juvenile type 2 diabetes mellitus and obesity in Korea: a pilot study

• Seo JY
• Lee CG
• Choi H
• Lee HK
• Lee SY
• Kim HJ
• Jung KY
• Kim JT

• KMID: 2549323
• DOI: http://doi.org/10.6065/apem.2244196.098

Abstract

Purpose
We sought to investigate the effects and side effects of once-weekly dulaglutide treatment for type 2 diabetes mellitus (T2DM) in patients <18 years of age in Korea.
Methods
: From the Eulji University Hospital database, we identified all patients <18 years of age diagnosed with T2DM and treated with dulaglutide from January 1, 2017, to July 31, 2022.
Results
We identified 5 patients <18 years of age treated with dulaglutide for T2DM management. Their mean (standard deviation [SD]) age was 16.6 (0.5) years. Four (80%) patients were female. The mean (SD) body mass index was 29.4 (5.1) kg/m², and the mean (SD) age at diagnosis was 15.2 (1.6) years. Four patients had been treated previously with metformin alone or in combination with insulin. Four patients were treated with 1.5 mg of dulaglutide and one was treated with 0.75 mg of dulaglutide. The mean (SD) hemoglobin A1c concentrations at baseline, 3 months after treatment, and 1 year after treatment, respectively, were 10.0% (2.2%), 6.5% (1.5%), and 6.7% (1.4%), with significant differences. In addition, at baseline, 3 months after treatment, and 1 year after treatment, the mean (SD) body weight values were 79.7 (13.3) kg, 80.2 (14.0) kg, and 81.1 (15.3) kg, with no significant difference.
Conclusion
Use of once-weekly dulaglutide for juvenile T2DM ensures very good glycemic control, with few side effects and good adherence, indicating its potential as a promising therapeutic agent in this age group. Nationwide studies are warranted to confirm our results.

Keyword

Adolescent; Dulaglutide; Obesity; Type 2 diabetes mellitus

Figure

• 

  Fig. 1. Changes in the body weight (A) and hemoglobin A1c concentration (B) of each patient during the 12-month period.

Reference

References

1. Yoon KH, Lee JH, Kim JW, Cho JH, Choi YH, Ko SH, et al. Epidemic obesity and type 2 diabetes in Asia. Lancet. 2006; 368:1681–8.

2. Mayer-Davis EJ, Dabelea D, Lawrence JM. Incidence trends of type 1 and type 2 diabetes among youths, 2002-2012. N Engl J Med. 2017; 377:301.

3. Bjornstad P, Drews K, Zeitler PS. Long-term complications in youth-onset type 2 diabetes. Reply. N Engl J Med. 2021; 385:2016.

4. Zuhri-Yafi MI, Brosnan PG, Hardin DS. Treatment of type 2 diabetes mellitus in children and adolescents. J Pediatr Endocrinol Metab. 2002; 15 Suppl 1:541–6.

5. Reinehr T, Schober E, Roth CL, Wiegand S, Holl R; DPV-Wiss Study Group. Type 2 diabetes in children and adolescents in a 2-year follow-up: insufficient adherence to diabetes centers. Horm Res. 2008; 69:107–13.

6. Jaser SS. Psychological problems in adolescents with diabetes. Adolesc Med State Art Rev. 2010; 21:138–51. x-xi.

7. Lawrence JM, Standiford DA, Loots B, Klingensmith GJ, Williams DE, Ruggiero A, et al. Prevalence and correlates of depressed mood among youth with diabetes: the SEARCH for Diabetes in Youth study. Pediatrics. 2006; 117:1348–58.

8. Lascar N, Brown J, Pattison H, Barnett AH, Bailey CJ, Bellary S. Type 2 diabetes in adolescents and young adults. Lancet Diabetes Endocrinol. 2018; 6:69–80.

9. Tamborlane WV, Barrientos-Perez M, Fainberg U, Frimer-Larsen H, Hafez M, Hale PM, et al. Liraglutide in children and adolescents with type 2 diabetes. N Engl J Med. 2019; 381:637–46.

10. Tamborlane WV, Bishai R, Geller D, Shehadeh N, Al-Abdulrazzaq D, Vazquez EM, et al. Once-weekly exenatide in youth with type 2 diabetes. Diabetes Care. 2022; 45:1833–40.

11. Gerstein HC, Colhoun HM, Dagenais GR, Diaz R, Lakshmanan M, Pais P, et al. Dulaglutide and cardiovascular outcomes in type 2 diabetes (REWIND): a double-blind, randomised placebo-controlled trial. Lancet. 2019; 394:121–30.

12. Gerstein HC, Colhoun HM, Dagenais GR, Diaz R, Lakshmanan M, Pais P, et al. Dulaglutide and renal outcomes in type 2 diabetes: an exploratory analysis of the REWIND randomised, placebo-controlled trial. Lancet. 2019; 394:131–8.

13. Arslanian SA, Hannon T, Zeitler P, Chao LC, Boucher-Berry C, Barrientos-Perez M, et al. Once-weekly dulaglutide for the treatment of youths with type 2 diabetes. N Engl J Med. 2022; 387:433–43.

14. Dahlqvist S, Ahlen E, Filipsson K, Gustafsson T, Hirsch IB, Tuomilehto J, et al. Variables associated with HbA1c and weight reductions when adding liraglutide to multiple daily insulin injections in persons with type 2 diabetes (MDI Liraglutide trial 3). BMJ Open Diabetes Res Care. 2018; 6:e000464.

15. Bonora E, Frias JP, Tinahones FJ, Van J, Malik RE, Yu Z, et al. Effect of dulaglutide 3.0 and 4.5 mg on weight in patients with type 2 diabetes: exploratory analyses of AWARD-11. Diabetes Obes Metab. 2021; 23:2242–50.

16. Narasimhan S, Weinstock RS. Youth-onset type 2 diabetes mellitus: lessons learned from the TODAY study. Mayo Clin Proc. 2014; 89:806–16.

17. Gungor N, Bacha F, Saad R, Janosky J, Arslanian S. Youth type 2 diabetes: insulin resistance, beta-cell failure, or both? Diabetes Care. 2005; 28:638–44.

18. Baldi JC, Manning PJ, Hofman PL, Walker RJ. Comment on: TODAY Study Group. Effects of metformin, metformin plus rosiglitazone, and metformin plus lifestyle on insulin sensitivity and beta-cell function in TODAY. Diabetes Care. 2013; 36:1749–1757. Diabetes Care 2013;36:e223.

19. Drucker DJ. Mechanisms of action and therapeutic application of glucagon-like peptide-1. Cell Metab. 2018; 27:740–56.

20. Kim MS, Kim J, Cho J, Cho SY, Jin DK. Tailored management of life-threatening complications related to severe obesity in a young adult with Prader-Willi syndrome. Ann Pediatr Endocrinol Metab. 2022; 27:148–52.

21. American Diabetes Association. Type 2 diabetes in children and adolescents. Diabetes Care. 2000; 23:381–9.

22. Merger SR, Kerner W, Stadler M, Zeyfang A, Jehle P, Muller-Korbsch M, et al. Prevalence and comorbidities of double diabetes. Diabetes Res Clin Pract. 2016; 119:48–56.

23. Nieto T, Castillo B, Nieto J, Redondo MJ. Demographic and diagnostic markers in new onset pediatric type 1 and type 2 diabetes: differences and overlaps. Ann Pediatr Endocrinol Metab. 2022; 27:121–5.