The Effects of Once-Weekly Dulaglutide and Insulin Glargine on Glucose Fluctuation in Poorly Oral-Antidiabetic Controlled Patients with Type 2 Diabetes Mellitus

Abstract

Aim. To compare the effects of once-weekly Dulaglutide with once-daily glargine in poorly oral-antidiabetic controlled patients with type 2 diabetes mellitus (T2DM). Method. A total of 25 patients with T2DM admitted into Department of Endocrinology from December 2012 to August 2013 were randomly assigned into two groups: Dulaglutide group (<mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M1"><mml:mrow><mml:mi>n</mml:mi><mml:mo>=</mml:mo><mml:mn>16</mml:mn></mml:mrow></mml:math>) and glargine group (<mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M2"><mml:mrow><mml:mi>n</mml:mi><mml:mo>=</mml:mo><mml:mn>9</mml:mn></mml:mrow></mml:math>). All patients received either Dulaglutide or glargine treatments for 52 weeks. Continuous glucose monitoring systems (CGMS) were applied to them for two 72 h periods at before and after the treatment each. Patient general clinical data were collected and analyzed. Result. Fast blood glucose ( FBG) of the glargine group declined more significantly than the Dulaglutide group after treatment (<mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M3"><mml:mrow><mml:mi>p</mml:mi><mml:mo>&lt;</mml:mo><mml:mn>0.05</mml:mn></mml:mrow></mml:math>). The mean blood glucose (MBG), standard deviation of blood glucose (SDBG), mean amplitude of glycemic excursion (MAGE) within a day, the largest amplitude of glycemic excursion (LAGE), <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M4"><mml:mi>M</mml:mi></mml:math>-value, absolute means of daily difference (MODD) of glycemic excursion, the percentage of time (≤2.8 mmol/L, ≤3.9 mmol/L, ≥10.0 mmol/L, ≥13.9 mmol/L, 3.9–7.8 mmol/L, and 9–10.0 mmol/L), maximum glycemic value, and minimum glycemic value were similar between the two groups (<mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M5"><mml:mrow><mml:mi>p</mml:mi><mml:mo>&gt;</mml:mo><mml:mn>0.05</mml:mn></mml:mrow></mml:math>). The incidence of hypoglycemia was also similar between the two groups (<mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M6"><mml:mrow><mml:mi>p</mml:mi><mml:mo>&gt;</mml:mo><mml:mn>0.05</mml:mn></mml:mrow></mml:math>). Though serum levels of TNF- α , IL-6, and 8-PGF2 α all decreased, significant reduction was found in TNF- α and 8-PGF2 α . TNF- α was only significantly reduced in the Dulaglutide group, while 8-PGF2 α was seen in both groups. Conclusion. For T2DM patients with poorly controlled oral antidiabetic drugs, once-weekly Dulaglutide not only has the same effect on glucose fluctuation as once-daily glargine but also significantly reduced TNF- α and 8-PGF2 α after a 52 week treatment protocol. This trial is registered with ClinicalTrials.gov NCT01648582 .