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June 12, 2026Diabetes

GLP-1 use linked to ~89% lower risk of suicidal ideation or behavior vs metformin in youth.

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Why the study?

Increasing GLP-1 receptor agonist use among children and adolescents with obesity or youth-onset type 2 diabetes has raised concerns regarding potential risks of suicidal ideation or behaviors, depression, and anxiety.

Does GLP-1 RA use reduce the risk of suicidal ideation/behaviors, depression, and anxiety in children and adolescents with obesity or youth-onset type 2 diabetes compared to metformin?

Population

Children and adolescents aged 6 to younger than 18 years with obesity or YT2D

Comparison

New users of GLP-1 RAs vs prevalent users of metformin

Design

Retrospective cohort study using a target trial emulation approach

Follow-up

Up to 4 years

Key result

GLP-1 receptor agonist use in children and adolescents with obesity or type 2 diabetes was associated with a lower risk of suicidal ideation or behaviors than metformin (HR 0.11; 95% CI 0.02-0.86).

Authors

PKPareeta KotechaYLYao An LeeABAngelina Bernier

Discussion

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Overview

May not yet change prescribing in youth with diabetes; leaves open causality and needs randomized confirmation.

Key Points

  • This study assesses the impact of GLP-1 receptor agonist use on suicidal ideation, depression, and anxiety in youth with obesity or type 2 diabetes.
  • Retrospective cohort study using electronic health records from January 2020 to January 2024.
  • Compared new users of GLP-1 receptor agonists with prevalent users of metformin.
  • Employed stabilized inverse probability of treatment weighting and Cox proportional hazards models for analysis.
  • GLP-1 receptor agonist users had lower rates of suicidal ideation/behavior (RD: -10.45; HR: 0.11) and depression (RD: -25.64; HR: 0.37) compared to metformin users.
  • No significant difference in anxiety risk was found between GLP-1 RA and metformin users (RD: 5.95; HR: 1.13).

Study Design

Type

Cohort (n=2,010)

Multicenter

Yes

Structured PICO

Does GLP-1 RA use reduce the risk of suicidal ideation/behaviors, depression, and anxiety in children and adolescents with obesity or youth-onset type 2 diabetes compared to metformin?

P
Population
2,010 children and adolescents aged 6 to <18 years with obesity or youth-onset type 2 diabetes, followed for up to 4 years.
E
Exposure
GLP-1 receptor agonists (new users)
C
Comparator
Metformin (prevalent users)
O
Outcome
Incidence of suicidal ideation or behavior (SI/SB), depression, and anxietysafety

Main Result

Hazard Ratio: 0.11 (95% CI 0.02–0.86)

In children and adolescents with obesity or type 2 diabetes, GLP-1 receptor agonist use is associated with a significantly lower risk of suicidal ideation/behaviors and depression compared to metformin use.

Cite This Study

Kotecha et al. (2026) conducted a cohort in Obesity or youth-onset type 2 diabetes (n=2,010). GLP-1 receptor agonists vs. Metformin was evaluated on Suicidal ideation or behavior (SI/SB) (HR 0.11, 95% CI 0.02 to 0.86). GLP-1 receptor agonist use in children and adolescents with obesity or type 2 diabetes was associated with a lower risk of suicidal ideation or behaviors than metformin (HR 0.11; 95% CI 0.02-0.86).

synapsesocial.com/papers/6a2bd1386550ea4541ffe92dhttps://doi.org/10.2337/db26-2069-p
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1GLP-1 receptor agonists and suicidal ideation/behavior: subject-level analysis of clinical trials2026
  2. 2GLP-1 receptor agonist use and mental health outcomes in adolescents with obesity: a retrospective review2026
  3. 3Efficacy and Safety of GLP-1 RAs in Children and Adolescents With Obesity or Type 2 Diabetes2025 · 37 citations
  4. 4Risk of depression with <scp>GLP</scp>‐1 receptor agonists use in overweight or obese adults with type 2 diabetes: A new‐user, active‐comparator cohort study2025 · 13 citations
  5. 5Neuropsychiatric Outcomes Associated with GLP-1 Receptor Agonists in Adults with Overweight or Obesity: A Systematic Review2026