What is the age limit for Glucagon-like peptide-1 (GLP-1) analogues, such as liraglutide (Victoza), semaglutide (Ozempic), or dulaglutide (Trulicity), for patients with type 2 diabetes?

Age Limits for GLP-1 Receptor Agonists

GLP-1 receptor agonists are approved for use in pediatric patients aged 10 years and older with type 2 diabetes, with no upper age limit for older adults. 1, 2

Pediatric Population (Lower Age Limit)

The minimum age for GLP-1 receptor agonist use is 10 years old for type 2 diabetes. 1

• The 2025 American Diabetes Association guidelines specifically recommend GLP-1 receptor agonists for children aged 10 years or older with type 2 diabetes who have not met glycemic targets with metformin (with or without basal insulin). 1

• FDA-approved dulaglutide (Trulicity) has established safety and effectiveness in pediatric patients 10 years of age and older with type 2 diabetes, supported by a 26-week randomized controlled trial in 154 pediatric patients. 2

• Safety and effectiveness have NOT been established in children younger than 10 years of age. 2

Important Pediatric Considerations:

• GLP-1 receptor agonists should NOT be used in youth with a personal or family history of medullary thyroid carcinoma or multiple endocrine neoplasia type 2. 1

• Pediatric patients treated with GLP-1 receptor agonists report higher incidence of injection site-related reactions compared to adults. 2

• Randomized controlled trials in youth have demonstrated that GLP-1 receptor agonists are safe and effective for decreasing A1C and promoting weight loss at higher doses approved for obesity. 1

Older Adult Population (Upper Age Limit)

There is no upper age limit for GLP-1 receptor agonist use in older adults. 1

• GLP-1 receptor agonists have demonstrated cardiovascular benefits in older adults, with no interaction by age group across major cardiovascular outcomes trials. 1

• In the dulaglutide REWIND trial, 53% of patients were 65 years or older, and 10% were 75 years or older at baseline, with no overall differences in safety or effectiveness observed. 2

• A systematic review and meta-analysis found that GLP-1 receptor agonists reduce major adverse cardiovascular events, cardiovascular deaths, stroke, and myocardial infarction to the same degree for patients above and below 65 years of age. 1

Practical Considerations for Older Adults:

• GLP-1 receptor agonists are injectable agents (except oral semaglutide), requiring visual, motor, and cognitive skills for appropriate administration. 1

• Weekly dosing schedules may reduce the burden of administration in older patients. 1

• Caution is warranted in older adults experiencing unexplained weight loss due to gastrointestinal side effects (nausea, vomiting, diarrhea). 1

• The LEADER trial showed complex age interactions: patients aged ≥50 years with established cardiovascular disease had cardiovascular benefit, while those aged ≥60 years without established cardiovascular disease had potentially adverse outcomes (except in a small subgroup aged ≥75 years). 1

Renal and Hepatic Considerations Across All Ages

• No dose adjustment is required for renal impairment, including end-stage renal disease, though caution is advised in ESRD patients. 2

• Use with caution in patients with hepatic impairment due to limited clinical experience, though no clinically relevant pharmacokinetic changes were observed. 2