{
  "abstract": "In this systematic review and meta-analysis, Kotecha et al (JAMA Pediatr 2025;179:1308–1317. doi: 10.1001/jamapediatrics.3243) have examined the efficacy and safety of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) in children and adolescents with obesity, overweight, pre-diabetes or type 2 diabetes mellitus (T2DM). Eighteen randomised controlled trials comparing GLP-1 RAs to placebo (11 in obesity, 6 in T2D and 1 in pre-diabetes) in 1402 children and adolescents aged 6 to 17 years of age (838 GLP-1 RA users and 564 placebo) were included. GLP-1 RAs significantly reduced haemoglobin A1 c (−0.44%; 95% CI −0.68% to −0.21%), fasting glucose (−9.92 mg/dL; 95% CI −16.20 to −3.64), body weight (−3.02 kg; 95% CI −4.98 to −1.06), body mass index (BMI) (−1.45; 95% CI −2.40 to −0.49), BMI SD score (−0.20; 95% CI −0.36 to −0.05), BMI percentile (−7.24%; 95% CI −12.97% to −1.51%) and systolic blood pressure (−2.73 mm Hg; 95% CI −4.04 to −1.43). The main adverse events were gastrointestinal and more common in those taking GLP-1 RAs. The incidence of depression, suicidal ideation or behaviours, and hepatobiliary disorders was not significantly different from placebo. So, the short-term outcomes look promising, but there are no long-term studies. The treatment duration intervention was a median (IQR) treatment duration of 0.51 years (0.25–1.00) and a median (IQR) follow-up duration of 0.19 years (0.05–0.49). The Archivist is mainly concerned with the effect of these drugs on the growing child, stepping into adolescence; what do these drugs do to bone growth, muscle development, puberty, psychological and brain development? We do not know the long-term impact on these very important outcomes. Long-term studies are needed. Sanaka et al (JAMA Pediatr 2025; 179:1263–1264. doi: 10.1001/jamapediatrics.2025.4110) discuss these issues in an accompanying article. They present an ethical approach to the decision on the use of these drugs. One has to focus on safe and equitable care and understand the complexity of decision-making in this paediatric population. They present a structure to support your decision-making using the bioethical principles of autonomy, beneficence, justice and non-maleficence. There are many unanswered questions. A really useful table highlights five central concepts that are backed up by these bioethical principles; starting the conversation for those who may benefit, providing education about available medications, shared decision-making about initiation and ongoing use, assisting with navigating how to obtain medications and providing ongoing follow-up and support for healthy lifestyle change.",
  "authors": [
    {
      "affiliations": [],
      "name": "BMJ Publishing Group Ltd and Royal College of Paediatrics and Child Health"
    }
  ],
  "title": "Obesity, diabetes and glucagon-like peptide-1 receptor agonists",
  "uid": "fa78eff4-5e7c-545e-8413-f4883b70ca1f"
}