Endocrinol Metab.  2025 Feb;40(1):156-160. 10.3803/EnM.2024.2150.

Metabolic Consequences of Glucagon-Like Peptide-1 Receptor Agonist Shortage: Deterioration of Glycemic Control in Type 2 Diabetes

• Choe HJ
• Nauck MA
• Moon JH

• KMID: 2565263
• DOI: http://doi.org/10.3803/EnM.2024.2150

Abstract

In the context of a global shortage of glucagon-like peptide-1 (GLP-1) receptor agonists, we assessed the impact of discontinuing dulaglutide on metabolic control in individuals with type 2 diabetes. Our analysis included data from 69 individuals and revealed a significant deterioration in glycemic control following the discontinuation. Specifically, the average hemoglobin A1c level increased from 7.0%±0.9% to 8.1%±1.4% (P<0.001), and fasting glucose levels rose from 129±31 to 156±50 mg/dL (P<0.001) within 3 months after stopping the medication. Alternative treatments such as dipeptidyl peptidase-4 inhibitors and sodium glucose cotransporter- 2 inhibitors were insufficient substitutes, highlighting the essential role of continuous GLP-1 receptor agonist therapy in maintaining metabolic health.

Keyword

Diabetes mellitus, type 2; Glucagon-like peptide-1 receptor agonists; Glycemic control

Figure

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  Fig. 1. Metabolic changes following discontinuation or switching of glucagon-like peptide-1 receptor agonist therapy in individuals with type 2 diabetes. This figure presents comparative boxplots illustrating changes in hemoglobin A1c (HbA1c; %), fasting plasma glucose (mg/dL), and body mass index (BMI; kg/m2) from baseline to 3 months after either stopping dulaglutide without replacement or switching to other glucose-lowering medications due to a shortage of dulaglutide. Each panel focuses on a different metabolic parameter: (A) blue illustrates changes in HbA1c; (B) green shows changes in fasting plasma glucose levels (mg/dL); and (C) red depicts changes in BMI. Within each panel, the groups “total,” “stop,” “dipeptidyl peptidase-4 inhibitor (DPP4i),” and “sodium glucose cotransporter-2 inhibitor (SGLT2i)” are compared. Baseline values are annotated at the bottom of each plot. The central line in each box represents the median, while the edges of the box indicate the 25th and 75th percentiles. aP<0.05; bP<0.01; cP<0.001 levels of statistical significance compared to the baseline.

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