Immediate Glucose-Lowering Effect After the First Administration of Dulaglutide: A Retrospective, Single-Center, Observational Study

Abstract

Introduction: Dulaglutide is a long-acting glucagon-like peptide 1 receptor agonist that is administered once weekly for the treatment of type 2 diabetes. However, the immediate glucose-lowering effect of dulaglutide after the first administration and the factors affecting the efficacy of the drug remain unclear.

Methods: This study was a retrospective and observational study of 80 subjects with type 2 diabetes conducted in a hospitalized setting. The changes (Δ) in the blood glucose (BG) levels at six time points (6-point BG levels) from the baseline (day - 1) to the day after the first administration of 0.75 mg of dulaglutide (day 1) were evaluated. The associations of the Δ 6-point BG levels with the patients' characteristics and laboratory data were also analyzed.

Results: Significant reduction of the fasting BG, preprandial BG, postprandial BG, and standard deviation (SD) of the 6-point BG levels was observed on day 1 as compared to day - 1 (P < 0.0001) and the reduced BG levels were maintained throughout the remaining observation period of 5 days. The baseline serum hemoglobin A1c and glycoalbumin levels were positively correlated with the reduction of the fasting BG. The Δ BG levels were not related to the parameters of insulin-secreting capacity. Insulin treatment was positively associated with the reduction of the 6-point BG levels. Patients without cerebrovascular disease and patients without diabetic retinopathy showed greater improvements of the fasting BG and SD of the 6-point BG levels, respectively. Urinary microalbumin level was positively correlated with improvements of the 6-point BG levels. Dulaglutide reduced the BG levels, irrespective of the previously used class of antidiabetic medication(s).

Conclusion: Dulaglutide achieved reduction in glucose level within 24 h of the first injection. The improvement in the BG levels remained stable for a week in the hospitalized clinical setting.

Keywords: Dulaglutide; Glucagon-like peptide 1 receptor agonist; Type 2 diabetes.

Fig. 1

Study design. (1) to (6) indicate the timing of glucose levels measurements at 7:30, 10:30, 11:30, 14:30, 17:30, and 20:30, respectively. The triangles show meal times; breakfast at 8:30, lunch at 12:30, and dinner at 18:30. Dulaglutide was injected just before breakfast on day 0

Fig. 2

Six-point BG levels at the baseline (day − 1) and on the day after the first dulaglutide administration (day 1). Day 0 indicates the day of administration of dulaglutide. BG levels, blood glucose levels. **P < 0.01 vs. day − 1, ****P < 0.0001 vs. day − 1. All data shown are the arithmetic means ± SD

Fig. 3

Changes in the blood glucose excursions, expressed as the SD of the 6-point BG levels, from the baseline (day − 1) to the day after the first administration of dulaglutide (day 1). Day 0 indicates the day of administration of dulaglutide. SD, standard deviation of the 6-point blood glucose levels. ****P < 0.0001 vs. day − 1. All data shown are the median values ± (25–75%)

Fig. 4

Changes in the fasting, preprandial, postprandial, and in the SD of the 6-point BG levels. Day 0 indicates the day of administration of dulaglutide. BG levels, blood glucose levels; SD, standard deviation. a Fasting blood glucose levels, b Preprandial blood glucose levels, c Postprandial blood glucose levels, d Standard deviation. ***P < 0.001 vs. day − 1, ****P < 0.0001 vs. day − 1. All data show are the median values ± (25–75%)