Endocrine Abstracts

Introduction: Glucagon-like peptide-1 agonists (GLP1a) and dipeptidyl peptidase-4 inhibitors (DPP4i) are both incretin-based therapies for type 2 diabetes (T2DM) but with distinct efficacy according to glycemic and weight control and side effect profiles. There is scarce information about changes observed after switching from a DPP4i to a GLP1a in patients with T2DM on a complex treatment regimen and routine clinical practice conditions. To assess these changes, we carried out this study to analyze if there were any beneficial effects of switching from DPP4i to once-weekly dulaglutide (a GLP1a) in poorly controlled patients with T2DM. Safety of that switch was also evaluated.

Methods/Design: An observational and retrospective study was carried out in T2DM poorly controlled patients in routine clinical practice. Variables used to assess efficacy were changes in HbA1c, fasting plasma glucose (FPG) and weight from switching to week 12 to 20 (period 1) and week 21–36 (period 2). Additionally, changes in antidiabetic drugs to maintain adequate glycemic control were evaluated. Safety variables were: hypoglycemic events and side effects related to GLP1a.

Results: Data from 60 patients (age: 61.3 ± 9.4 years; HbA1c: 8.6 ± 1.3%; duration of T2DM: 13.4 ± 8.4 years) were collected. 63.3% of the cohort was on insulin. A significant reduction (P < 0.001) in HbA1c, FPG and weight was observed in both periods of follow-up: HbA1c: –1.39% (CI 95%: –1.7 to –1.1) and –1.37% (CI 95%: –1.6 to –0.9); FPG: –33.2 mg/dl (CI 95%: –61.4 to –16.7) and –34.6 mg/dl (CI 95%: –57.3 to –18.2); weight: 2.14 kg (CI 95%: –3.99 to –2.36) and –3.36 (CI 95%: –3.35 to –1.45). In patients on insulin, a significant reduction in insulin doses was observed only in the first period (–0.13 IU/kg; P = 0.031). Any intensification of antidiabetic treatment was required in 7.8% and 30.9% of the cohort in period 1 and 2, respectively. At least, one hypoglycemic event (no severe) was described in 12.7% of the patients. No patients required withdrawal from dulaglutide during follow-up.

Conclusions: Switching from DPP4i to GLP1a (dulaglutide) in patients with T2DM, and routine clinical practice, of our cohort, resulted in sustained HbA1c, FPG and weight reductions without compromising safety.