Dulaglutide switch from insulin lowers HbA1c, body weight in type 2 diabetes
Adults with type 2 diabetes in South Korea had lower HbA1c and body weight 6 months after switching from insulin to the GLP-1 receptor agonist dulaglutide, according to a study published in Diabetes/Metabolism Research and Reviews.
“In the present real‐world study, the replacement of insulin by once-weekly dulaglutide for 6 months was effective in reducing HbA1c concentrations and body weight in patients with type 2 diabetes,” Woo Je Lee, MD, PhD, a professor in the department of endocrinology and metabolism at Asan Diabetes Center in Seoul, South Korea, and colleagues wrote. “Higher baseline HbA1c was found to be an independent predictor of the glucose‐lowering response to dulaglutide in this patient cohort.”
Researchers conducted a retrospective review of the electronic medical records from patients with type 2 diabetes treated at Asan Medical Center who switched from insulin to dulaglutide (Trulicity, Eli Lilly) from 2017 to 2019. Researchers analyzed changes in HbA1c from baseline to 6 months as the primary endpoint and changes in fasting plasma glucose and body weight as secondary endpoints.
The study included 98 patients who were switched from insulin to dulaglutide and continued dulaglutide therapy for at least 6 months; 94 were previously treated with a combination of insulin and an oral diabetes drug. After starting dulaglutide, 77 participants were treated with metformin and sulfonylurea also, and 18 were treated with a combination of metformin, sulfonylurea and SGLT2 inhibitors.
After 6 months of dulaglutide, mean HbA1c difference from baseline was –0.95% (95% CI, –1.3 to –0.59; P < .001) and mean body weight difference from baseline was –1.75 kg (95% CI, –2.42 to –1.08; P < .001). No change was observed with FPG. Of the participants, 73 had a reduction in HbA1c, and 38 lowered their HbA1c by more than 1%. In multiple linear regression analysis, higher baseline HbA1c was a predictor of reduced HbA1c with 6 months of dulaglutide.
After 6 months of dulaglutide, no difference was observed in HbA1c or FPG between adults treated with long-acting insulin and those treated with both short- and long-acting insulin. However, those treated with short- and long-acting insulin had a mean weight loss of 3.69 kg compared with a mean weight loss of 1.25 kg for those treated with long-acting insulin only.
“Weight reduction was significantly greater in patients treated with both long- and short‐acting insulin than in patients treated with long‐acting insulin alone, which seems to be contributed by both decrease in higher dose of insulin and the weight‐reducing effect of dulaglutide,” the researchers wrote. “Our current analyses provide evidence that switching from all types of insulin, including short‐acting insulin, to once‐weekly dulaglutide can benefit patients by reducing HbA1c concentration and body weight.”
Of the study cohort, 84 started dulaglutide with a 0.75 mg weekly dose and 14 received a 1.5 mg weekly dose. After 6 months, 70 participants received 1.5 mg of dulaglutide weekly and 28 received 0.75 mg.
There were adverse events reported in 27.6% of participants after 3 months of dulaglutide and 8.2% after 6 months. Gastrointestinal adverse events, particularly nausea, were the most commonly reported. There were no reports of hypoglycemia, and the number of adverse events decreased over time.
“Weekly treatment with dulaglutide could be an alternative to insulin therapy in patients with type 2 diabetes in a real‐world situation,” the researchers wrote. “Dulaglutide can improve glycemic control and reduce body weight, while avoiding the hypoglycemia observed with insulin treatment.”