GLP-1 receptor agonists in pediatric obesity and diabetes: a systematic review of efficacy, metabolic effects, and safety

GLP-1 receptor agonist drugs improve BMI and blood sugar control in children and adolescents with obesity or type 2 diabetes. A systematic review of 901 participants found that semaglutide produced the largest BMI reduction in adolescents with obesity, while liraglutide and dulaglutide improved HbA1c in youth diabetes. Gastrointestinal side effects were the most common and were mostly temporary.

Systematic review — Systematic review of randomized controlled trials and meta-analyses. Population: Children and adolescents aged 6 to <18 years with obesity or youth-onset type 2 diabetes, identified through PubMed-indexed studies published 2000 to 2025.. Sample size: 901 participants. Interventions: GLP-1 receptor agonists; semaglutide 2.4 mg/week; liraglutide 3.0 mg/day; liraglutide 1.8 mg/day; dulaglutide.

The review of seven pivotal RCTs and six meta-analyses involving 901 participants aged 6 to <18 years found that semaglutide 2.4 mg/week produced the greatest BMI reduction in adolescents with obesity, followed by liraglutide 3.0 mg/day, which also improved BMI SDS in adolescents and younger children. In youth-onset type 2 diabetes, liraglutide 1.8 mg/day and dulaglutide significantly improved HbA1c compared with placebo. Weight-reducing agents improved insulin resistance and modestly reduced triglycerides, while LDL-cholesterol changes were minimal. Gastrointestinal adverse events, mainly nausea and vomiting, were the most frequent and were generally transient and dose dependent, and no significant adverse effects on linear growth or pubertal progression were reported.

Researchers studying semaglutide or liraglutide will find this review useful for placing pediatric weight and glycemic outcomes in context: semaglutide showed the largest BMI reduction in adolescents with obesity, while liraglutide improved BMI SDS across ages and HbA1c in youth with diabetes. The paper does not establish long-term cardiovascular, bone, or growth safety, and it does not provide head-to-head comparisons between these agents.

Key findings

Semaglutide 2.4 mg/week produced the greatest BMI reduction in adolescents with obesity, followed by liraglutide 3.0 mg/day.
Liraglutide 1.8 mg/day and dulaglutide significantly improved HbA1c compared with placebo in youth-onset type 2 diabetes.
Weight-reducing agents improved insulin resistance and modestly reduced triglycerides, while LDL-cholesterol changes were minimal.
Gastrointestinal adverse events, mainly nausea and vomiting, were the most frequent and were generally transient and dose dependent.
No significant adverse effects on linear growth or pubertal progression were reported.

Limitations

The authors state that longer-term studies are needed to assess cardiovascular safety, bone health, and growth outcomes.
The evidence base is modest, consisting of seven pivotal RCTs and six meta-analyses with 901 participants.
Different agents, doses, and age groups across the included studies limit direct comparisons between semaglutide and liraglutide.
No head-to-head trials or long-term cardiovascular and bone safety outcomes are established.

The record

Journal: Diabetes research and clinical practice 238: 113400
Published: 2026-06-28
PMID: 42365860 — DOI: 10.1016/j.diabres.2026.113400
MeSH terms: Humans, Diabetes Mellitus, Type 2, Blood Glucose, Recombinant Fusion Proteins, Hypoglycemic Agents, Adolescent, Child, Immunoglobulin Fc Fragments, Glucagon-Like Peptides, Pediatric Obesity, Liraglutide, Glucagon-Like Peptide-1 Receptor Agonists, Semaglutide
Author countries: Qatar

Peptide profiles: Semaglutide, Liraglutide.

All indexed evidence: Semaglutide trials & papers, Liraglutide trials & papers.