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Review
. 2025 Nov 18.
doi: 10.1007/s13300-025-01823-7. Online ahead of print.

Pros and Cons of Early Treatment with GLP-1 Receptor Agonist and SGLT-2 Inhibitors for Youth with Type 2 Diabetes: A Narrative Review

Sean E DeLacey  1   2 , Abigayil C Dieguez  3   4 , Megan O Bensignor  5   6
Affiliations
Review

Pros and Cons of Early Treatment with GLP-1 Receptor Agonist and SGLT-2 Inhibitors for Youth with Type 2 Diabetes: A Narrative Review

Sean E DeLacey et al. Diabetes Ther. .

Abstract

The incidence of youth-onset type 2 diabetes (Y-T2D) has been increasing over the last two decades in line with the growing rate of childhood obesity. Prior to 2019, the only United States Food and Drug Administration (FDA)-approved therapies for Y-T2D were metformin and insulin, and the current consensus guidelines recommend these therapies as first-line treatment. While metformin has a known safety profile and early efficacy for glycemic control, it has not been shown to prevent β-cell dysfunction or exogenous insulin requirements. Insulin is effective in treating hyperglycemia, but can result in hypoglycemia and further weight gain, worsening insulin resistance in Y-T2D. Furthermore, longitudinal data from participants treated early in their disease course with metformin and insulin demonstrate a cumulative incidence of at least one diabetes complication in most participants within 13 years of diagnosis. Over the last five years, glucagon-like peptide-1 receptor agonists (GLP-1RAs) and sodium-glucose co-transporter 2 inhibitors (SGLT-2is) have been added to the management toolbox for Y-T2D. However, further research is needed to determine the best timing and use for these medications for Y-T2D. The goal of this narrative review is to describe the current evidence for treatment with SGLT-2is and GLP-1RAs for Y-T2D within the first 1-2 years of the disease process.

Keywords: Complications; GLP-1RA; Glycemic control; Pediatrics; SGLT-2i; Therapeutics; Type 2 diabetes.

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Conflict of interest statement

Declarations. Conflict of Interest: Abigayil Dieguez declares that she has no competing interests. Megan O. Bensignor receives research support as a discounted study drug from Vivus Inc and discontinued monitors from Dexcom. Sean DeLacey receives research support for medical devices from Dexcom. Ethical Approval: This article is based on previously conducted studies and does not contain any new studies with human participants or animals performed by any of the authors.

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