Abstract
AimAt present, daily DPP-4 inhibitors are quite frequently prescribed in subjects with type 2 diabetes mellitus (T2DM). Recently, it has been drawing much attention that once-weekly incretin-based injection dulaglutide was developed. In this study, we aimed to examine the possible effects of once-weekly GLP-1 receptor activator (GLP-1RA) dulaglutide on glycemic control as well as various metabolic parameters.MethodsWe made a direct comparison between the effect of daily DPP-4 inhibitor and once-weekly dulaglutide on glycemic control in “study 1 (pre–post comparison)” and set the control group using the propensity score matching method in “study 2”.ResultsIn study 1, switching from daily DPP-4 inhibitor to dulaglutide significantly ameliorated glycemic control in subjects with T2DM. Such effects were more obvious in poorly controlled subjects. After 1:1 propensity score matching, the switching group improved glycemic control compared with the non-switching group in study 2.ConclusionWe should bear in mind that switching from daily DPP-4 inhibitor to once-weekly GLP-1RA dulaglutide exerts more favorable effects on glycemic control regardless of age, body weight, and duration of diabetes in subjects with T2DM, especially when we fail to obtain good glycemic control with daily DPP-4 inhibitor.
Highlights
Type 2 diabetes mellitus (T2DM) is well known to bring about both micro- and macroangiopathy when glycemic control is inadequate
The ACCORD study showed that strict glycemic control led to an increased number of deaths, which was presumably due to severe hypoglycemia induced by intensive glycemic control
Incretin preparations promote insulin secretion depending on blood glucose levels, and thereby the risk of hypoglycemia is very low with monotherapy of such medicine
Summary
Type 2 diabetes mellitus (T2DM) is well known to bring about both micro- and macroangiopathy when glycemic control is inadequate. According to the report of the Ministry of Health, Labor and Welfare in Japan at 2017, DPP-4 inhibitor accounted for over 40% of the total sales and is the most often used drug in clinical practice Another incretin-based medicine, GLP-1RA, accounted for only 5% of the total sales due to the inconvenience of being an injectable drug. Considering the mechanism of these drugs, it would be theoretically effective to change from DPP-4 inhibitor to GLP-1RA in subjects who are taking DPP-4 inhibitor but have insufficient blood glucose control. It was revealed the use of GLP-1RA was related to lower mortality compared with DPP-4 inhibitors or placebo [10]. We changed DPP-4 inhibitor to dulaglutide in poorly controlled T2DM subjects who were taking DPP-4 inhibitor, and we examined the changes in various metabolic parameters
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
