Placebo-controlled, randomized trial of the addition of once-weekly glucagon-like peptide-1 receptor agonist dulaglutide to titrated daily insulin glargine in patients with type 2 diabetes (AWARD-9).

Authors:
Paolo Pozzilli
Paolo Pozzilli
University Campus Bio-Medico
Italy
Dr Paul Norwood, MD
Dr Paul Norwood, MD
University of California at San Francisco
Associate Clinical Professor of Medicine at UC San Francisco
Diabetes, cholesterol, hypertension,
Fresno, CA | United States
Melanie J Davies
Melanie J Davies
University of Leicester
United Kingdom
Tibor Ivanyi
Tibor Ivanyi
Eli Lilly and Company
Indianapolis | United States
Honghua Jiang
Honghua Jiang
University of North Carolina School of Medicine
United States
Zvonko Milicevic
Zvonko Milicevic
Hadassah Hospital
Israel

Diabetes Obes Metab 2017 07 10;19(7):1024-1031. Epub 2017 Apr 10.

Eli Lilly and Company, Vienna, Austria.

Aim: To compare the addition of weekly dulaglutide vs the addition of placebo to titrated glargine in patients with type 2 diabetes (T2D) with sub-optimum glycated haemoglobin (HbA1c) concentration.

Materials And Methods: Patients (N = 300) from this phase III, double-blind, parallel-arm, placebo-controlled study were randomized to weekly subcutaneous injections of dulaglutide 1.5 mg or placebo with titrated daily glargine (mean ± standard deviation baseline dose: 39 ± 22 U), with or without metformin (≥1500 mg/d). The primary endpoint was superiority of dulaglutide/glargine to placebo/glargine with regard to change from baseline in HbA1c level at 28 weeks.

Results: Least squares (LS) mean ± standard error (s.e.) HbA1c changes from baseline were -1.44 ± 0.09% (-15.74 ± 0.98 mmol/mol) with dulaglutide/glargine and -0.67 ± 0.09% (-7.32 ± 0.98 mmol/mol) with placebo/glargine at 28 weeks (LS mean difference [95% confidence interval] -0.77% [-0.97, -0.56]; P < .001). Body weight decreased with dulaglutide/glargine and increased with placebo/glargine (LS mean difference: -2.41 ± 0.39 kg; P < .001). Increases from baseline in mean glargine dose were significantly smaller with dulaglutide/glargine vs placebo/glargine (13 ± 2 U [0.1 ± 0.02 U/kg] vs 26 ± 2 U [0.3 ± 0.02 U/kg], respectively; P < .001; LS mean ± s.e. final dose: dulaglutide/glargine, 51 ± 2 U; placebo/glargine, 65 ± 2 U). The hypoglycaemia rate (≤3.9 mmol/L threshold) was 7.69 ± 15.15 and 8.56 ± 16.13 events/patient/year, respectively (P = .488). One episode of severe hypoglycaemia occurred in the dulaglutide/glargine group. Common gastrointestinal adverse events with dulaglutide were nausea (12.0%), diarrhoea (11.3%) and vomiting (6.0%).

Conclusions: Weekly dulaglutide 1.5 mg added to basal insulin is an efficacious and well tolerated treatment option for patients with T2D.

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July 2017
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(Supplied by CrossRef)
The biology of incretin hormones
Drucker et al.
Cell Metab 2006
Biology of incretins: GLP-1 and GIP
Baggio et al.
Gastroenterology 2007

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