GLP-1 receptor agonist medications should be the preferred second-line therapy for children under 18 with type 2 diabetes, despite the drugs not yet being TGA approved for this age group, according to new guidelines.

The guidelines, published by the Australian and New Zealand Society for Paediatric Endocrinology and Diabetes (ANZSPED), reflect growing evidence supporting newer diabetes medications for youth-onset type 2 diabetes, which progresses more rapidly than adult-onset disease.

Extended-release metformin remains first-line therapy, with insulin recommended for patients presenting with marked hyperglycaemia or metabolic decompensation.

Metformin should be commenced if HbA1c is ≤8.5% at diagnosis without waiting for paediatric review, while insulin should be first-line treatment for patients with HbA1c over 8.5%, diabetic ketoacidosis, hyperglycaemic hyperosmolar state or ketosis, in combination with metformin.