A Novel Approach to Managing "Double Diabetes" in a Pediatric Patient on Insulin Pump Therapy: An Off-Label Use of a Fixed-Ratio Insulin Degludec/Liraglutide Combination.

Almoallem B, Thalange NK

Cureus19 Aug 2026

PMID42761866PMCIDPMC13587759DOI10.7759/cureus.114782PepBankPUB-42761866

Summary

The convergence of type 1 diabetes (T1D) and features of type 2 diabetes, such as obesity and insulin resistance, has given rise to the concept of "double diabetes" (DD). This condition poses significant management challenges in the pediatric population, as escalating insulin requirements may exacerbate weight gain and insulin resistance, creating a vicious cycle. Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are not approved for pediatric T1D but represent a potential therapeutic avenue. We present the case of an 11-year-old girl with antibody-positive T1D on an insulin pump who developed significant features of DD, including obesity, acanthosis nigricans, and escalating insulin requirements that exceeded her pump reservoir capacity. To address both insulin deficiency and severe insulin resistance, a novel off-label approach was initiated using a fixed-ratio combination of basal insulin degludec and the GLP-1 RA liraglutide (IDegLira), administered once daily as an adjunct to her continued insulin pump therapy for bolus insulin delivery. Over an eight-month follow-up period, the patient demonstrated modest weight loss (-2.2 kg) and a reduction in BMI z-score, with a marked improvement in glycemic control. Her mean glucose decreased from 196 mg/dL to 139 mg/dL, and her glucose management indicator improved from 8.0% to 6.6%. Time spent in severe hyperglycemia (>250 mg/dL) was reduced from 26% to 15%. The adjunctive therapy reduced the total daily insulin dose delivered via the pump. This case report highlights the potential utility of a pragmatic, off-label approach that combines a fixed-ratio GLP-1 RA with basal insulin to manage the challenges of pediatric DD. It addressed insulin resistance, improved glycemic control, and mitigated the burdensome cycle of weight gain and escalating insulin doses. This report underscores the need for further research into tailored, multifaceted therapeutic strategies for this growing patient population.

CC BYText from Europe PMC. Highlighted sentences are the source of results.

Results from this study6

No result from this study comes from a test of the peptide.

Studies that did not test the peptide alone6

In this study, Liraglutide was a lab tool or a carrier, part of a mix, or the subject of a lab method. These results are not evidence about taking Liraglutide.

01HumanNot a test of Liraglutide aloneCase report or seriesEfficacy outcome
In an 11-year-old girl with antibody-positive type 1 diabetes and obesity, fixed-ratio degludec/liraglutide plus pump insulin was followed by 2.2-kg weight loss over eight months.
In plain wordsIn an 11-year-old girl with type 1 diabetes and obesity, the combined degludec/liraglutide and pump-insulin regimen was followed by 2.2-kg weight loss.
Peptide
Liraglutide
Outcome
DecreaseBody weight
Study
n = 1
Outcome group
Body weight · Metabolic and weight
Measurements
Body weight change
−2.2 kg
eight-month follow-up
Source sentences
Summary
Over an eight-month follow-up period, the patient demonstrated modest weight loss (-2.2 kg) and a reduction in BMI z-score, with a marked improvement in glycemic control.
2 context sentences(design, population, supporting numbers)
Summary · context
We present the case of an 11-year-old girl with antibody-positive T1D on an insulin pump who developed significant features of DD, including obesity, acanthosis nigricans, and escalating insulin requirements that exceeded her pump reservoir capacity.
Summary · context
To address both insulin deficiency and severe insulin resistance, a novel off-label approach was initiated using a fixed-ratio combination of basal insulin degludec and the GLP-1 RA liraglutide (IDegLira), administered once daily as an adjunct to her continued insulin pump therapy for bolus insulin delivery.
In this study, Liraglutide was a lab tool or a carrier, part of a mix, or the subject of a lab method. This result is not evidence about taking Liraglutide.
Show in the study text Report a problemFND-4276186601
02HumanNot a test of Liraglutide aloneCase report or seriesEfficacy outcome
In an 11-year-old girl with antibody-positive type 1 diabetes and obesity, fixed-ratio degludec/liraglutide plus pump insulin was followed by reduced BMI z-score.
In plain wordsIn an 11-year-old girl with type 1 diabetes and obesity, the combined degludec/liraglutide and pump-insulin regimen was followed by lower BMI z-score.
Peptide
Liraglutide
Outcome
DecreaseBMI z-score
Study
n = 1
Outcome group
Body weight · Metabolic and weight
Source sentences
Summary
Over an eight-month follow-up period, the patient demonstrated modest weight loss (-2.2 kg) and a reduction in BMI z-score, with a marked improvement in glycemic control.
2 context sentences(design, population, supporting numbers)
Summary · context
We present the case of an 11-year-old girl with antibody-positive T1D on an insulin pump who developed significant features of DD, including obesity, acanthosis nigricans, and escalating insulin requirements that exceeded her pump reservoir capacity.
Summary · context
To address both insulin deficiency and severe insulin resistance, a novel off-label approach was initiated using a fixed-ratio combination of basal insulin degludec and the GLP-1 RA liraglutide (IDegLira), administered once daily as an adjunct to her continued insulin pump therapy for bolus insulin delivery.
In this study, Liraglutide was a lab tool or a carrier, part of a mix, or the subject of a lab method. This result is not evidence about taking Liraglutide.
Show in the study text Report a problemFND-4276186602
03HumanNot a test of Liraglutide aloneCase report or seriesEfficacy outcome
In an 11-year-old girl with type 1 diabetes and obesity, fixed-ratio degludec/liraglutide plus pump insulin was followed by mean glucose falling from 196 to 139 mg/dL.
In plain wordsIn an 11-year-old girl with type 1 diabetes and obesity, the combined regimen was followed by lower mean glucose.
Peptide
Liraglutide
Outcome
DecreaseMean glucose
Study
n = 1
Outcome group
Glycemic control · Metabolic and weight
Measurements
Mean glucose
196 mg/dL
before treatment
Mean glucose
139 mg/dL
eight-month follow-up
Source sentences
Summary
Her mean glucose decreased from 196 mg/dL to 139 mg/dL, and her glucose management indicator improved from 8.0% to 6.6%.
2 context sentences(design, population, supporting numbers)
Summary · context
We present the case of an 11-year-old girl with antibody-positive T1D on an insulin pump who developed significant features of DD, including obesity, acanthosis nigricans, and escalating insulin requirements that exceeded her pump reservoir capacity.
Summary · context
To address both insulin deficiency and severe insulin resistance, a novel off-label approach was initiated using a fixed-ratio combination of basal insulin degludec and the GLP-1 RA liraglutide (IDegLira), administered once daily as an adjunct to her continued insulin pump therapy for bolus insulin delivery.
In this study, Liraglutide was a lab tool or a carrier, part of a mix, or the subject of a lab method. This result is not evidence about taking Liraglutide.
Show in the study text Report a problemFND-4276186603
04HumanNot a test of Liraglutide aloneCase report or seriesEfficacy outcome
In an 11-year-old girl with type 1 diabetes and obesity, fixed-ratio degludec/liraglutide plus pump insulin was followed by glucose management indicator falling from 8.0% to 6.6%.
In plain wordsIn an 11-year-old girl with type 1 diabetes and obesity, the combined regimen was followed by lower glucose management indicator.
Peptide
Liraglutide
Outcome
DecreaseGlucose management indicator
Study
n = 1
Outcome group
Glycemic control · Metabolic and weight
Measurements
Glucose management indicator
8%
before treatment
Glucose management indicator
6.6%
eight-month follow-up
Source sentences
Summary
Her mean glucose decreased from 196 mg/dL to 139 mg/dL, and her glucose management indicator improved from 8.0% to 6.6%.
2 context sentences(design, population, supporting numbers)
Summary · context
We present the case of an 11-year-old girl with antibody-positive T1D on an insulin pump who developed significant features of DD, including obesity, acanthosis nigricans, and escalating insulin requirements that exceeded her pump reservoir capacity.
Summary · context
To address both insulin deficiency and severe insulin resistance, a novel off-label approach was initiated using a fixed-ratio combination of basal insulin degludec and the GLP-1 RA liraglutide (IDegLira), administered once daily as an adjunct to her continued insulin pump therapy for bolus insulin delivery.
In this study, Liraglutide was a lab tool or a carrier, part of a mix, or the subject of a lab method. This result is not evidence about taking Liraglutide.
Show in the study text Report a problemFND-4276186604
05HumanNot a test of Liraglutide aloneCase report or seriesEfficacy outcome
In an 11-year-old girl with type 1 diabetes and obesity, fixed-ratio degludec/liraglutide plus pump insulin was followed by time above 250 mg/dL falling from 26% to 15%.
In plain wordsIn an 11-year-old girl with type 1 diabetes and obesity, the combined regimen was followed by less time above 250 mg/dL.
Peptide
Liraglutide
Outcome
DecreaseTime in severe hyperglycemia
Study
n = 1
Outcome group
Glycemic control · Metabolic and weight
Measurements
Time in severe hyperglycemia
26%
>250 mg/dL before treatment
Time in severe hyperglycemia
15%
>250 mg/dL eight-month follow-up
Source sentences
Summary
Time spent in severe hyperglycemia (>250 mg/dL) was reduced from 26% to 15%.
2 context sentences(design, population, supporting numbers)
Summary · context
We present the case of an 11-year-old girl with antibody-positive T1D on an insulin pump who developed significant features of DD, including obesity, acanthosis nigricans, and escalating insulin requirements that exceeded her pump reservoir capacity.
Summary · context
To address both insulin deficiency and severe insulin resistance, a novel off-label approach was initiated using a fixed-ratio combination of basal insulin degludec and the GLP-1 RA liraglutide (IDegLira), administered once daily as an adjunct to her continued insulin pump therapy for bolus insulin delivery.
In this study, Liraglutide was a lab tool or a carrier, part of a mix, or the subject of a lab method. This result is not evidence about taking Liraglutide.
Show in the study text Report a problemFND-4276186605
06HumanNot a test of Liraglutide aloneCase report or seriesEfficacy outcome
In an 11-year-old girl with type 1 diabetes and obesity, fixed-ratio degludec/liraglutide plus pump insulin was followed by lower daily pump-delivered insulin.
In plain wordsIn an 11-year-old girl with type 1 diabetes and obesity, the combined regimen was followed by lower daily pump-delivered insulin.
Peptide
Liraglutide
Outcome
DecreaseTotal daily insulin dose
Study
n = 1
Outcome group
Glycemic control · Metabolic and weight
Source sentences
Summary
The adjunctive therapy reduced the total daily insulin dose delivered via the pump.
2 context sentences(design, population, supporting numbers)
Summary · context
We present the case of an 11-year-old girl with antibody-positive T1D on an insulin pump who developed significant features of DD, including obesity, acanthosis nigricans, and escalating insulin requirements that exceeded her pump reservoir capacity.
Summary · context
To address both insulin deficiency and severe insulin resistance, a novel off-label approach was initiated using a fixed-ratio combination of basal insulin degludec and the GLP-1 RA liraglutide (IDegLira), administered once daily as an adjunct to her continued insulin pump therapy for bolus insulin delivery.
In this study, Liraglutide was a lab tool or a carrier, part of a mix, or the subject of a lab method. This result is not evidence about taking Liraglutide.
Show in the study text Report a problemFND-4276186606

AI wrote and checked these results. AI can make mistakes, so check important results against the source.

Version history

PepBank keeps every version of the data on this study. Status changes from Retraction Watch, Europe PMC and Crossref are listed with their source.

Version 2Current
12 Oct 2026, 11:11 UTC
Study results updated
Version 1
9 Oct 2026, 03:04 UTC
First added · source update from Europe PMC

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