Diabetes Metab J.  2021 Nov;45(6):948-953. 10.4093/dmj.2020.0180.

Dulaglutide as an Effective Replacement for Prandial Insulin in Kidney Transplant Recipients with Type 2 Diabetes Mellitus: A Retrospective Review

• Kim HS
• Lee J
• Jung CH
• Park JY
• Lee WJ

• KMID: 2522733
• DOI: http://doi.org/10.4093/dmj.2020.0180

Abstract

Dulaglutide, a weekly injectable glucagon-like peptide-1 receptor agonist, has demonstrated effectiveness when combined with basal insulin. We examined whether the efficacy of dulaglutide is comparable to that of prandial insulin in kidney transplant (KT) recipients with type 2 diabetes mellitus (T2DM) undergoing multiple daily insulin injection (MDI) therapy. Thirty-seven patients, who switched from MDI therapy to basal insulin and dulaglutide, were retrospectively analyzed. Changes in glycosylated hemoglobin (HbA1c) and fasting plasma glucose (FPG) levels, body weight, and basal insulin dose were evaluated over 6 months. Dulaglutide was comparable to three injections of prandial insulin in terms of glycemic control (HbA1c 7.1% vs. 7.0%; 95% confidence interval [CI], –0.53 to 0.28; P=0.53). The basal insulin and dulaglutide combination resulted in a reduction in FPG levels by 9.7 mg/dL (95% CI, 2.09 to 41.54; P=0.03), in body weight by 4.9 kg (95% CI, 2.87 to 6.98; P<0.001), and in basal insulin dose by 9.52 IU (95% CI, 5.80 to 3.23; P<0.001). Once-weekly dulaglutide may be an effective alternative for thrice-daily prandial insulin in KT recipients with T2DM currently receiving MDI therapy.

Keyword

Diabetes mellitus, type 2; Dulaglutide; Insulin

Figure

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  Fig. 1. Measures of therapeutic efficacy of dulaglutide over 6 months. (A) Glycosylated hemoglobin (HbA1c), (B) fasting plasma glucose (FPG), (C) body weight, and (D) basal insulin dose. IU, international unit.

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Reference

1. Suthanthiran M, Strom TB. Renal transplantation. N Engl J Med. 1994; 331:365–76.

2. Pozzilli P, Norwood P, Jodar E, Davies MJ, Ivanyi T, Jiang H, et al. Placebo-controlled, randomized trial of the addition of once-weekly glucagon-like peptide-1 receptor agonist dulaglutide to titrated daily insulin glargine in patients with type 2 diabetes (AWARD-9). Diabetes Obes Metab. 2017; 19:1024–31.

3. Lee J, Cho YK, Kim HS, Jung CH, Park JY, Lee WJ. Dulaglutide as an add-on to insulin in type 2 diabetes; clinical efficacy and parameters affecting the response in real-world practice. Diabetes Metab Syndr Obes. 2019; 12:2745–53.

4. Htike ZZ, Zaccardi F, Papamargaritis D, Webb DR, Khunti K, Davies MJ. Efficacy and safety of glucagon-like peptide-1 receptor agonists in type 2 diabetes: a systematic review and mixed-treatment comparison analysis. Diabetes Obes Metab. 2017; 19:524–36.

5. Qie S, Li X, Wang X, Liu Y, Li J, Liu G. Efficacy and safety of long-acting glucagon-like peptide-1 receptor agonist dulaglutide in patients with type 2 diabetes: a systematic review and meta-analysis of 21 randomized controlled trials. Endocrine. 2020; 68:508–17.

6. Mody R, Grabner M, Yu M, Turner R, Kwan AY, York W, et al. Real-world effectiveness, adherence and persistence among patients with type 2 diabetes mellitus initiating dulaglutide treatment. Curr Med Res Opin. 2018; 34:995–1003.

7. Yamamoto S, Hayashi T, Ohara M, Goto S, Sato J, Nagaike H, et al. Comparison of liraglutide plus basal insulin and basalbolus insulin therapy (BBIT) for glycemic control, body weight stability, and treatment satisfaction in patients treated using BBIT for type 2 diabetes without severe insulin deficiency: a randomized prospective pilot study. Diabetes Res Clin Pract. 2018; 140:339–46.

8. Rosenstock J, Guerci B, Hanefeld M, Gentile S, Aronson R, Tinahones FJ, et al. Prandial options to advance basal insulin glargine therapy: testing lixisenatide plus basal insulin versus insulin glulisine either as basal-plus or basal-bolus in type 2 diabetes: the GetGoal Duo-2 trial. Diabetes Care. 2016; 39:1318–28.

9. Rosenstock J, Fonseca VA, Gross JL, Ratner RE, Ahren B, Chow FC, et al. Advancing basal insulin replacement in type 2 diabetes inadequately controlled with insulin glargine plus oral agents: a comparison of adding albiglutide, a weekly GLP-1 receptor agonist, versus thrice-daily prandial insulin lispro. Diabetes Care. 2014; 37:2317–25.

10. Miya A, Nakamura A, Miyoshi H, Cho KY, Nagai S, Kurihara Y, et al. Satisfaction of switching to combination therapy with lixisenatide and basal insulin in patients with type 2 diabetes receiving multiple daily insulin injection therapy: a randomized controlled trial. J Diabetes Investig. 2018; 9:119–26.

11. Singh P, Pesavento TE, Washburn K, Walsh D, Meng S. Largest single-centre experience of dulaglutide for management of diabetes mellitus in solid organ transplant recipients. Diabetes Obes Metab. 2019; 21:1061–5.

12. Kukla A, Hill J, Merzkani M, Bentall A, Lorenz EC, Park WD, et al. The use of GLP1R agonists for the treatment of type 2 diabetes in kidney transplant recipients. Transplant Direct. 2020; 6:e524.

13. Li Z, Zhang Y, Quan X, Yang Z, Zeng X, Ji L, et al. Efficacy and acceptability of glycemic control of glucagon-like peptide-1 receptor agonists among type 2 diabetes: a systematic review and network meta-analysis. PLoS One. 2016; 11:e0154206.