Dulaglutide as an Add-on to Insulin in Type 2 Diabetes; Clinical Efficacy and Parameters Affecting the Response in Real-World Practice

Abstract

Purpose

For patients with type 2 diabetes (T2DM) who remain above their glycemic target on insulin therapy, a combination of insulin and a glucagon-like peptide 1 receptor agonist has been recommended. However, few studies have been conducted to determine the clinical efficacy and parameters affecting the response to this combination in a real-world setting. This study aimed to investigate the clinical efficacy and parameters affecting the glycemic response to dulaglutide as an add-on to insulin therapy for T2DM in a real-world clinical setting.

Patients and methods

A retrospective study was performed in 120 patients with T2DM who had initiated dulaglutide as an add-on to insulin therapy between January 2017 and December 2018. After 6 months of treatment, the change in glycated hemoglobin (HbA1c) was evaluated. Multiple linear regression analysis was used to determine the parameters affecting the therapeutic response to dulaglutide.

Results

The mean age of the patients was 55.1 years and 57.5% were male. The mean baseline HbA1c, body mass index, and duration of diabetes were 9.1%, 27.5 kg/m², and 17.2 years, respectively. The change in HbA1c between baseline and 6 months was −0.97% (95% confidence interval [CI]: −1.28 to −0.66%, P<0.001), the change in body weight was −2.05 kg (95% CI: −2.93 to −1.17 kg, P<0.001), and the change in total daily insulin dose was −11.67 IU (95% CI: −14.55 to −8.78 IU, P<0.001). In multiple linear regression analysis, higher baseline HbA1c was associated with a greater reduction in HbA1c. The most frequent adverse events were gastrointestinal symptoms, but these were well-tolerated.

Conclusion

Dulaglutide treatment in combination with insulin resulted in a significant improvement in HbA1c and body weight over a 6-month period in a real-world clinical setting. Higher baseline HbA1c was associated with a good clinical response.

Keywords:

• dulaglutide
• glucagon-like peptide-1 receptor agonist
• insulin therapy
• glycemic control
• diabetes mellitus

Abbreviations

AWARD, Assessment of Weekly Administration of LY2189265 in Diabetes; BMI, body mass index; CI, confidence interval; FPG, fasting plasma glucose; GFR, glomerular filtration rate; GLP-1 RA, glucagon-like peptide-1 receptor agonist; HbA1c, glycated hemoglobin; HDL-C, high-density lipoprotein-cholesterol; IU, international units; LDL-C, low-density lipoprotein-cholesterol; OAD, oral anti-diabetic drug; PP2, postprandial 2 hr plasma glucose; SD, standard deviation; T2DM, type 2 diabetes mellitus; TC, total cholesterol; TG, triglyceride.

Disclosure

The authors report no conflicts of interest in this work.

Additional information

Funding

This research did not receive any specific grants from any funding agency in the public, commercial, or not-for-profit sector.