Role of Glucagon-like Peptide-1 Receptor Agonists in Menstrual Irregularities in Adolescent Females With Type 1 Diabetes Mellitus

All studied patients with T1DM with poor glycemic control will be screened for menstrual irregularities based upon detailed history Taking, those who were found to have menstrual irregularities will be subdivided into 2 groups:

• Group 1: will receive additional dulaglutide at a dose escalating from o.75 to 1.5 mg /week for 12 weeks to the conventional insulin therapy.
• Group 2: will only receive conventional insulin therapy. Dulaglutide is an FDA-approved drug in the U.S.; however, this study is conducted entirely outside the United States and is not under an FDA IND.

Inclusion criteria

• Diagnosis of Type 1 Diabetes Mellitus according to ISPAD criteria
• Use of continuous glucose monitoring (CGM)
• Receiving regular insulin therapy
• Regular follow-up at a diabetes clinic
• Female participants aged 12 to 18 years
• At least 2 years post-menarche
• Poor glycemic control, defined as HbA1c ≥ 7%

Exclusion criteria

• Presence of medical conditions known to cause menstrual irregularities, including:(Connective tissue disorders, Autoimmune diseases, Clinical thyroid dysfunction, Neurological diseases).
• History of severe hypoglycemia within the past 12 months
• Other causes of abnormal uterine bleeding, including:(Structural causes (e.g., leiomyoma, endometrial polyp), Coagulation disorders, Ovulatory disorders (e.g., hyperprolactinemia, hyperandrogenism), Iatrogenic causes (e.g., steroid therapy, oral contraceptive use)
• Family history of medullary thyroid carcinoma or multiple endocrine neoplasia History of pancreatitis