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Future research should aim to validate our findings in larger and more diverse pediatric cohorts, and to explore potential differences in subgroups with varying severity of GHD or higher levels of injection-related anxiety

Sulfonylureas represent a cost-effective option, particularly suitable for patients who: Cannot tolerate or have contraindications to other agents Require oral medication (needle-phobic or unable to self-inject) Have no significant hypoglycaemia risk factors Are not overweight or where weight gain is acceptable Need rapid glycaemic improvement Incretin mimetics (GLP-1 receptor agonists) are recommended as second- or third-line options, particularly when: BMI 35 kg/m (or appropriately lower thresholds for people from minority ethnic groups, as per NICE guidance) and weight-related comorbidities are present Significant hypoglycaemia risk exists (elderly, occupational hazards, driving requirements) Weight loss would provide substantial clinical benefit Cardiovascular protection is desired in patients with established ASCVD (liraglutide, dulaglutide, and injectable semaglutide have demonstrated cardiovascular outcome benefits in clinical trials) [13] NICE NG28 specifies that GLP-1 receptor agonists should be continued only if there is a beneficial metabolic response at 6 months, defined as a reduction of at least 11 mmol/mol (1.0%) in HbA1c and a weight loss of at least 3% of initial body weight

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Data derived from Phase 2 obesity trials