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Dulaglutide over Insulin Glargine in the Reduction of HbA1c?

GLP-1 analog also showed reduction in weight and incidence of hypoglycemia…

Dulaglutide (Trulicity) is a glucagon-like peptide analog that is used once weekly to improve blood glucose level.

During the open-label, multinational, parallel arm study, researchers compared the safety and efficacy of dulaglutide 0.75mg and 1.5mg to insulin glargine in patients who were uncontrolled by sulfonylurea and/or metformin. A total of 789 patients were randomly assigned to insulin glargine and dulaglutide (83.9% Asian; mean HbA1c, 8.36%; mean weight, 73.8 kg). Dulaglutide was well tolerated and the incidence of hypoglycemia was lower in both insulin glargine and dulaglutide groups.

Within 26 weeks of the study, both doses of dulaglutide were superior to insulin glargine in reducing HbA1c. The results showed a 1.7% decrease in HbA1c from baseline in the dulaglutide 1.5-mg group, 1.32% in the dulaglutide 0.75-mg group vs. 1.15% in the insulin glargine group. Also, a reduction in weight was seen in patients using dulaglutide 0.75mg and 1.5mg losing an average 0.88kg and 1.51kg. The adverse effects reported during the study were gastrointestinal problems. More patients taking dulaglutide experience diarrhea (15.2% and 8.4% vs. 1.6%) and nausea (8.7% and 4.9% vs. 0.8%) compared to insulin glargine.

Insulin glargine was used in patients who were not controlled using metformin and/or sulfonylurea. Seeing the effects of dulaglutide showing a reduction in HbA1c, researchers concluded that it was an effective and safe alternative in patients with type 2 diabetes who failed other therapies to achieve glycemic control.

Practice Pearls:

  • In the study, 65% of patients taking dulaglutide 1.5 mg and 54% of those taking dulaglutide 0.75 mg achieved target HbA1c levels of less than 7%, as compared with 41% of those taking insulin glargine.
  • Dulaglutide has a positive effect on weight loss as compared to insulin glargine.
  • No severe hypoglycemia was reported and the incidence of hypoglycemia was lower in both dulaglutide group than in insulin glargine group.

Wang W et al. Abstract 280-OR: Efficacy and Safety of Once-Weekly Dulaglutide vs. Insulin Glargine in Combination with Metformin and/or a Sulfonylurea in Predominantly Asian Patients with Type 2 Diabetes. Presented at: American Diabetes Association (ADA) 75th Scientific Sessions; June 5-9, 2015; Boston.