Dulaglutide-Combined Conventional Insulin Therapy Contributes to Ideal Glycemic Control in Noncritically Ill Hospitalized Patients

Abstract

Object: We investigated whether dulaglutide (DU)-combined conventional insulin therapy is beneficial for glycemic control in noncritically ill hospitalized patients with type-2 diabetes. Method: This study was a prospective, randomized-controlled pilot study. Participants were randomized to either basal-plus (BP) therapy, those receiving basal insulin and corrective doses of regular insulin before meals, or BP+DU therapy, those receiving BP therapy combined with DU. Blood glucose (BG) levels before and after every meal were measured for 7 days after assignment. Because we consider the ideal BG during hospitalization to be within 100-180 mg/dL, we define this range as the hospitalized ideal glucose range (hIGR). We compared the percentage of hIGR with all measured BGs (%hIGR), mean BG, glucose variability (GV), and insulin dose. Result: Of 54 patients participating in the study, 27 were assigned to the BP group and 27 to the BP+DU group. The %hIGR was significantly higher and percentage of BG >240 and BG <70 was significantly lower in the BP+DU compared with the BP group. The mean BG, SD, coefficient of variation, and total regular insulin dose in the BP+DU group were significantly lower than those in the BP group (Table). No significant side effects were observed.BP groupBP+DU groupn=974, N=27n=899, N=27P valueBaseline characteristicsAge, years70.1±1470.9±130.822Male, N (%)18 (67)15 (56)0.577BMI, kg/m224.6±5.725.1±6.70.904Duration, years10.1±8.88.7±9.40.488HbA1c, %8.0±1.98.2±1.70.401Frequency of the measured BGs in each BG ranges, n (%)BG <7021 (2.3)4 (0.4)<0.001BG 71–9963 (7)99 (10)0.019BG 100–180 (%hIGR)399 (44)545 (56)<0.001BG 181–240232 (26)244 (25)0.748BG >240184 (21)82 (8)<0.001Daily BG profiles, mean±SD mg/dLFasting131±38127±400.254After breakfast244±61196±540.004Before lunch216±65173±56<0.001After lunch195±62182±540.041Before dinner135±47143±440.232After dinner203±62177±54<0.001mean BG after first day183±29162±300.014Glucose variability, mean±SDIndividual glucose SD during study62.5±2145.0±140.001Individual glucose CV during study0.34±0.090.27±0.050.002Hypoglycemic event, N (%)Patients <70 mg/dL9 (33)3 (11)0.099Insulin therapy, mean±SD U/dayTotal insulin17.1±6.616.1±6.40.762Total glargine insulin12.0±5.712.6±4.80.55Total regular insulin5.4±2.53.6±2.80.017n, number of the measured BGs; N, number of the patients Conclusion: BP+DU therapy reduced the frequency of hyperglycemia and hypoglycemia and resulted in a lower GV. Disclosure N. Fushimi: None. T. Shibuya: None. Y. Yoshida: None. S. Ito: None. H. Hachiya: None. A. Mori: None.