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Relative contribution of basal and postprandial hyperglycaemia stratified by HbA1c categories before and after treatment intensification with dulaglutide
Author(s) -
Umpierrez Guillermo,
Pantalone Kevin M.,
Atisso Charles M.,
Landó Laura Fernández,
Patel Hiren
Publication year - 2019
Publication title -
diabetes, obesity and metabolism
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.445
H-Index - 128
eISSN - 1463-1326
pISSN - 1462-8902
DOI - 10.1111/dom.13662
Subject(s) - dulaglutide , postprandial , medicine , exenatide , basal (medicine) , type 2 diabetes , insulin glargine , basal insulin , area under the curve , liraglutide , diabetes mellitus , endocrinology , insulin
Aim To assess the effect of dulaglutide on the relative contribution of basal hyperglycaemia (BHG) and postprandial hyperglycaemia (PPHG) to overall hyperglycaemia across HbA1c categories in patients with type 2 diabetes. Methods Data from five phase 3 studies (N = 673) were pooled to assess the change in relative contributions of BHG and PPHG to overall hyperglycaemia across different HbA1c categories after 6 months of treatment intensification with dulaglutide 1.5 mg as monotherapy or with 1 or 2 oral medication(s) in patients with type 2 diabetes. BHG and PPHG were calculated using the area under the curve (AUC) of 7‐point self‐monitored plasma glucose concentration profiles. As a secondary objective, relative contribution of BHG and PPHG for dulaglutide versus liraglutide, exenatide BID and insulin glargine was assessed by individual studies at 6 months. Results In pooled data, after 6 months of treatment intensification with dulaglutide 1.5 mg, there was a significant reduction from baseline in overall hyperglycaemia (AUC overall ) [(mean ± SE) ‐466.31 ± 18.32 mg*h/dL ( P < 0.001)], BHG (AUC basal ) [(mean ± SE) ‐371.46 ± 16.36 mg*h/dL ( P < 0.001)] and PPHG (AUC postprandial ) [(mean ± SE) ‐94.84 ± 7.97 mg*h/dL ( P < 0.001)]. At baseline, relative contributions of BHG increased and PPHG decreased with increasing HbA1c levels. This pattern was maintained at 6 months, even as overall glycaemia improved with decreasing HbA1c values. Conclusions In patients with type 2 diabetes, dulaglutide reduces HbA1c by lowering both basal and postprandial hyperglycaemia across various HbA1c levels.