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Pharmacological management of type 2 diabetes mellitus in children and adolescents: A systematic review and network meta-analysis
Gagnon, Charles A. Buchanan, Katherine Deaver, Jill M. Schmitt, Jessica A. Shetty, Sahana Ashraf, Ambika P. Pappachan, Joseph M.
Gagnon, Charles A.
Buchanan, Katherine
Deaver, Jill M.
Schmitt, Jessica A.
Shetty, Sahana
Ashraf, Ambika P.
Pappachan, Joseph M.
Editors
Other contributors
Affiliation
Epub Date
Issue Date
2025-07-15
Submitted date
Alternative
Abstract
BACKGROUND
The incidence of type 2 diabetes mellitus (T2DM) in children and adolescents is increasing, yet there is limited information on the available pharmacological interventions to combat T2DM and prevent associated comorbidities.
AIM
To assess the effectiveness of current pharmacological treatments in managing T2DM in children and adolescents. The protocol of the study was registered in PROSPERO (CRD42022382165).
METHODS
Searches were performed in PubMed, EMBASE, Scopus, and ClinicalTrials.gov for publications between 1990 to September 2024 without language restrictions. Randomized control trials (RCTs) of pharmacotherapy in children and adolescents with T2DM (aged < 19 years) were included. The primary outcome was a change in glycated hemoglobin (HbA1c) from baseline to follow-up. Secondary outcomes were changes in body weight, body mass index (BMI), total cholesterol, triglycerides, high density lipoprotein, and low-density lipoprotein from baseline, and incidence of adverse events during study periods. Screening, full-text review, data extraction, and assessments of risk of bias were done by two reviewers. Conflicts on each step were resolved by a third reviewer. Data analysis was performed using Review Manager Version 6.5 (RevMan 6.5) and ‘R’ software via RStudio, ‘meta’ and ‘netmeta’.
RESULTS
A total of 12 studies having low to moderate risk of bias with 1658 participants, and follow-up duration 12-52 weeks were included. In our network meta-analysis, compared to control(s), the reduction of HbA1c was significantly larger for dulaglutide [mean difference (MD), 95% confidence interval: -1.20, -2.12 to -0.28], followed by dapagliflozin (-0.94, -1.44 to -0.44), liraglutide (-0.91, -1.37 to -0.45), empagliflozin (-0.87, -1.40 to -0.34), exenatide (-0.59, -1.07 to -0.11) and linagliptin (-0.45, -0.87 to -0.02) while other drugs had little or no effect. While liraglutide was associated with a change in body weight [MD -2.41 (-4.68, -0.14) kg], no other drug treatment was associated with significant changes in body weight, BMI, and lipids. Apart from level 1 hypoglycemia with liraglutide [risk difference (RD): 0.20, 0.04-0.37] and minor adverse events with dulaglutide (RD: 0.24, 0.08-0.40), no other treatment was associated with excess risk of hypoglycemia or minor or major adverse events.
CONCLUSION
Pharmacotherapy of T2DM with dulaglutide, dapagliflozin, liraglutide, empagliflozin, exenatide, and linagliptin in children is associated with modest reduction of HbA1c. Larger RCTs with longer follow-up durations are needed to guide better therapeutic decision making.
Citation
Gagnon CA, Buchanan K, Deaver JM, Schmitt JA, Lahart IM, Shetty S, Ashraf AP, Pappachan JM. Pharmacological management of type 2 diabetes mellitus in children and adolescents: A systematic review and network meta-analysis. World Journal of Diabetes 2025; 16(7): 106890
Publisher
Journal
Research Unit
PubMed ID
40697609 (pubmed)
PubMed Central ID
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Type
Journal article
Language
en
Description
© 2025 The Authors, published by Baishideng Publishing Group. This is an open access article available under a Creative Commons licence.
The published version can be accessed at the following link on the publisher’s website: http://dx.doi.org/10.4239/wjd.v16.i7.106890
Series/Report no.
ISSN
1948-9358
EISSN
1948-9358