Chronic iron overload represents a significant morbidity in Transfusion dependent β-thalassemia (TDT) leading to various endocrine complications including diabetes. The GLP-1 receptor agonist (GLP-1RA) Dulaglutide has recently been approved for pediatric type 2 diabetes (T2D) treatment.

Objectives: to assess the effect of Dulaglutide versus conventional insulin therapy on glycemic metrics, pancreatic reserve, dyslipidemia and ferritin among children and adolescents with TDT related diabetes.

A randomized controlled trial included 80 children and adolescents with TDT related diabetes. Participants were randomly assigned into two groups; the Dulaglutide group received subcutaneous Dulaglutide (0.75 mg weekly); while the insulin group received conventional basal-bolus insulin therapy. Participants were followed-up for 6 months with assessment of fasting blood glucose (FBG), HbA1c, fructosamine, fasting c-peptide, Freestyle libre2 Plus continuous glucose monitoring (CGM), hemolysis markers, serum ferritin, liver enzymes; as well as lipids profile.

Inclusion Criteria:

• Type 1 Diabetes
• Adolescents 12-18 years old

Exclusion Criteria:

• coexisting autoimmune diseases affecting glycemic control (e.g., celiac, autoimmune thyroiditis)
• diseases that require dietary restriction (e.g., celiac disease, food allergy, eating disorders)
• chronic diabetes complications (e.g., gastroparesis)
• and those with other types of diabetes, e.g., type 2 diabetes mellitus (T2D),