This information is for prescribers within general practice to support the on-going prescribing of liraglutide for children and young people (CYP) with type 2 diabetes (T2DM).
T2DM is becoming increasingly common among CYP, largely driven by rising global obesity rates. Key risk factors include excess body weight, having a first- or second-degree relative with T2DM, exposure to maternal diabetes during pregnancy, high‑risk racial or ethnic background, and insulin resistance. Signs of insulin resistance may include acanthosis nigricans and other metabolic conditions such as hypertension, hyperlipidaemia, polycystic ovarian syndrome (PCOS), or being born small for gestational age (SGA).
T2DM in young people is an aggressive disease with increased risk of complications leading to increased morbidity and mortality during most productive years of life. The pharmacological treatment options for CYP have been limited to metformin and insulin. However, the availability of the glucagon-like peptide-1 (GLP-1) agonist, liraglutide adds an additional option before moving to insulin.
At the time of this document development, two cost-effective biosimilars licensed for use in the UK for management of T2DM in adults and children aged 10 years or older (Zegluxen® and Diavic®) are available, however this document will be applicable to other cost-effective biosimilar that are licensed for use in children and young people aged 10 years and older with type 2 diabetes.
GLP-1 agonist – Liraglutide
GLP-1 agonists bind to and activate GLP-1 receptors to stimulate insulin secretion, lowering glucagon secretion when blood glucose is high, and delaying gastric emptying in the early post -prandial phase.
Liraglutide is currently licensed for use in CYP aged 10 years and above with T2DM when glycaemic control (HbA1c is more than 48 mmol/mol or 6.5%) has not improved with metformin alone or with basal insulin therapy, with or without diet and exercise.
Zegluxen® and Diavic® are available as pre‑filled pens containing 18 mg of liraglutide in 3 ml and are administered as daily subcutaneous injections.
It is important to note that liraglutide biosimilars may be licensed either for type 2 diabetes (as with the former Victoza®) or for obesity treatment (as with Saxenda®); due to these regulatory licensing differences, products are not interchangeable. This information sheet relates only to formulations licensed for the management of type 2 diabetes.
Initiation of liraglutide
- Initiation of liraglutide will be undertaken in secondary care and patients will be fully consented and counselled. The starting dose is 0.6mg daily, increased every 1 to 2 weeks up to 1.8mg once daily based on tolerability and fasting capillary blood glucose more than 6mmol/l.
- Subcutaneous administration is given in the abdomen, in the thigh or in the upper arm.
- The dose will be optimised by the specialist, before the GP is asked to take over prescribing. i.e. Amber 2 RAG rating.
Additional resources have been developed to support implementation including:
Prescribing Guidance
- General Practitioners are not obligated to accept transfer of prescribing responsibility if they feel it falls outside their scope of competency or if they have any concerns that continued specialist oversight is warranted.
- Liraglutide must be prescribed by brand.
- One pre-filled pen contains 18 mg liraglutide in 3ml. Daily dose of:
- 0.6mg -one pen will be sufficient for 1 month
- 1.2mg – two pens will be sufficient for 2 months
- 1.8mg- three pens will be sufficient for 3 months
- Both Zegluxen® and Divac® are available in a 2-pen or 3-pen pack.
- Needles will need to be prescribed separately.
- A yellow sharps bin may also be required.
Adverse effects and cautions
- Gastrointestinal side effects (nausea, diarrhoea, vomiting, dyspepsia) and fatigue. These usually disappear in the first few weeks.
- Cholelithiasis and cholecystitis are less common.
- Acute pancreatitis is rare.
There is no benefit in routine amylase monitoring as it can be transiently elevated by GLP -1 agonist without correlation with pancreatitis risk.
Patient Counselling
- Patients treated with liraglutide should be advised of the potential risk of dehydration in relation to gastrointestinal side effects and take precautions to avoid fluid depletion.
- Liraglutide should not be used during pregnancy. If a patient wishes to become pregnant, or pregnancy occurs, treatment with liraglutide should be discontinued and patient referred to their specialist for optimisation of their diabetes control and pharmacotherapy ideally in advance of the pregnancy.
For further details please see refer to the Summary of Product Characteristics.
Monitoring
Baseline (Undertaken by specialist team)
Baseline monitoring will be undertaken by the specialist and will include:
- HbA1c
- Weight, height & BMI
- Renal function
- Liver Function Tests
- Note most recent retinopathy screening result (only applicable if aged 12 years or older)
Follow up (by specialist team)
After initiation patient should be monitored/followed up at the following intervals:
- At 1 month: Review compliance, injection technique, injection site and
discuss any possible side -effects. - At 3 months: Check HbA1c, weight, review compliance and discuss any possible side effects.
- At 6 months: Check efficacy of treatment by checking HbA1c and weight.
Compare measurements with those taken at baseline and confirm whether patient meets NICE continuation criteria.
Undertaken by secondary care at review clinics:
- HbA1c
- Annual U&Es
- Renal impairment – discontinue if creatinine clearance less than 30ml/min.
- At 12 months: Consider discontinuing treatment if the response at 6 months
is not maintained, taking into consideration the progressive nature of T2DM.
Missed Doses
If a dose is more than 12 hours late, the missed dose should not be taken. The next dose should be taken at the normal time.
Advice and Guidance for General Practice
Healthcare professionals in General Practice may seek advice and guidance (as
appropriate) from the Paediatric Diabetes consultant if:
- Problems arise tolerating the GLP-1 agonist or if the GLP-1 agonist must be discontinued for other medical reasons.
- Patient develops any acute/serious diabetes complications.
- The patient is a young woman with diabetes who is planning a pregnancy or becomes pregnant. If the patient becomes pregnant, treatment should be stopped immediately, and the patient urgently referred to the Paediatric Consultant.
A free resource is available for primary care clinical teams who wish to upskill or refresh their knowledge in T2DM management in children and young people.
References
- A practical approach to management of type 2 diabetes in children and young people under 18 years (Association of children’s diabetes clinicians)
- Diabetes@ LP-1RA and other incretin mimetics – initiation guidance for primary care (NHS Greater Glasgow and Clyde)
- Guidance for general practitioners to support prescribing of liraglutide for children and young people under 28 years with T2DM (NHS Bedfordshire, Luton and Milton Keynes)
Document approved by IMOC December 2025.
Acknowledgement: Bedfordshire, Luton and Milton Keynes Health and Care partnership