Abstract
A meta-analysis was conducted to assess the clinical efficacy and safety of dulaglutide in patients with type 2 diabetes mellitus (T2DM). Medline, Embase, Cochrane Library and www. clinicaltrials. gov (up to February 15th, 2015) were searched. Randomized controlled trials comparing dulaglutide to other drugs for T2DM were collected. Twelve RCTs were included, and the overall bias was low. As the monotherapy, compared with control (placebo, metformin and liraglutide), dulaglutide resulted in a significant reduction in HbA1c (WMD, −0.68%; 95% CI, −0.95 to −0.40), FPG (WMD, −0.90 mmol/L; 95% CI, −1.28 to −0.52), a similar risk of hypoglycemia (7.8% vs. 10.6%), less body weight loss (WMD, 0.51 kg; 95% CI, 0.27 to 0.75). As an add-on intervention with oral antihyperglycemic medication (OAM) and insulin, compared with control (placebo, sitagliptin, exenatide, liraglutide and glargine), dulaglutide lowered HbA1c (WMD, −0.51%; 95% CI, −0.68 to −0.35) and body weight significantly (WMD, −1.30 kg, 95% CI, −1.85 to −1.02) notably, and elicited a similar reduction in FPG (WMD, −0.19 mmol/L; 95% CI, −1.20 to 0.82), an similar incidence of hypoglycemia (24.5% vs. 24.5%). This meta-analysis revealed the use of dulaglutide as a monotherapy or an add-on to OAM and lispro appeared to be effective and safe for adults with T2DM.
Highlights
Background treatmentMet + SU Met + TZD Met + DPP-IV inhibitorsOther OAD medication-naıve or had discontinued metformin monotherapyMetformin + pioglitazone metformin metformin diet and exercise metformin medication- naïveMetformin GlimepirideLispro sulfonylureas and/or biguanides medication- naïve a greater proportion of patients with HbA1c < 7% (68.1% vs. 10.9%, respectively; relative risk (RR), 4.97; 95% CI, 3.66 to 6.73) and ≤ 6.5% (42.1% vs. 2.9%; RR, 10.52; 95% CI, 5.66 to 19.54)
The percentage of patients reached the HbA1c target of ≤ 6.5% in the dulaglutide was more than in control groups (36.9% vs. 32.1%; RR, 1.47; 95% CI, 1.19 to 1.81)
When used as an add-on to metformin, the incidence of hypoglycemia with 0.75 mg dulaglutide was 5.3%, compared with 4.8% with 100 mg QD with sitagliptin; no difference was noted (RR, 1.11; 95% CI, 0.56 to 2.21)
Summary
Background treatmentMet + SU Met + TZD Met + DPP-IV inhibitorsOther OAD medication-naıve or had discontinued metformin monotherapyMetformin + pioglitazone metformin metformin diet and exercise metformin medication- naïveMetformin GlimepirideLispro sulfonylureas and/or biguanides medication- naïve a greater proportion of patients with HbA1c < 7% (68.1% vs. 10.9%, respectively; RR, 4.97; 95% CI, 3.66 to 6.73) and ≤ 6.5% (42.1% vs. 2.9%; RR, 10.52; 95% CI, 5.66 to 19.54). Compared with liraglutide (0.9mg), dulaglutide (0.75 mg) once weekly led to the similar reduction of HbA1c (− 1.43% vs − 1.33%; WMD, − 0.10%; 95% CI, − 0.27 to 0.07), similar percentage of patients that achieved HbA1c < 7% (71.4% vs 69.1%; RR, 1.12; 95% CI, 0.71 to 1.75) and ≤ 6.5% (50.0% vs 49.3%; RR, 1.03; 95% CI, 0.68 to 1.55)[19]. When used as an add-on to OAM and lispro, compared with control (placebo, sitagliptin, exenatide, liraglutide and glargine; n = 2328), dulaglutide (n = 3581) lowered HbA1c notably (WMD, − 0.51%; 95% CI, − 0.68 to − 0.35; Fig. 4)[8,10,11,13,14,16,17,18]. The percentage of patients reached the HbA1c target of ≤ 6.5% in the dulaglutide was more than in control groups (36.9% vs 32.1%; RR, 1.47; 95% CI, 1.19 to 1.81)
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