Effect of Dulaglutide and Long-Acting Insulin Combination Therapy in Patients with Type 2 Diabetes
Authors: ITO KOHEI , KONDO YOSHINOBU , SATOH SHINOBU , TERAUCHI YASUO 
Published: June 2018

Objective: In patients with diabetes, The use of GLP-1 receptor agonist expected to decreases the number of injections and improves blood glucose control. In this study, the effects were evaluated when changed from intensive insulin therapy to combination therapy of long-acting GLP-1 receptor agonist, duraglutide, and long-acting insulin.
Methods: We examined patients with type 2 diabetes who were admitted to our department and started blood glucose management with intensive insulin therapy, followed by flash glucose monitoring (FGM); we then switched to dulaglutide + long-acting insulin therapy. We analyzed the blood glucose excursion on intensive insulin therapy, 5 and 12 days after dulaglutide + long-acting insulin combination therapy change. Furthermore, we evaluated HbA1c and GA after 1 month of the change.
Result: We enrolled 20 patients with type 2 diabetes (age: 70.1 ± 11.1 years; history of diabetes: 20.8 ± 9.27 years). The blood glucose excursions during intensive insulin therapy and 5 and 12 days after dulaglutide + long-acting insulin combination therapy were 134.3 ± 43.1, 125.4 ± 28.2, and 110.1 ± 225.7 mg/dL, respectively. A significant decrease was observed in the blood glucose average on the day of intensive insulin therapy and 5 days after dulaglutide + long-acting insulin combination therapy. In addition, the blood glucose average was significantly decreased between days 5 and 12 after the dulaglutide + long-acting insulin combination therapy. Furthermore, the blood glucose standard deviation exhibited a declining trend after changing to dulaglutide + long-acting insulin combination therapy. After 1 month of the change, HbA1c and GA decreased significantly (−1.37% ± 1.87%, P = 0.007 and −7.01% ± 4.51%, P = 0.016, respectively).
Conclusions: The transition from intensive insulin therapy to dulaglutide + long-acting insulin therapy demonstrated better blood glucose control with reduced blood glucose excursion and the number of self-injections.

Disclosure
K. Ito: None. Y. Kondo: None. S. Satoh: None. Y. Terauchi: Research Support; Self; MSD K.K.. Speaker's Bureau; Self; MSD K.K.. Advisory Panel; Self; MSD K.K.. Research Support; Self; Ono Pharmaceutical Co., Ltd.. Speaker's Bureau; Self; Ono Pharmaceutical Co., Ltd.. Research Support; Self; Novartis Pharma K.K., Boehringer Ingelheim GmbH. Speaker's Bureau; Self; Boehringer Ingelheim GmbH. Advisory Panel; Self; Boehringer Ingelheim GmbH. Research Support; Self; Mitsubishi Tanabe Pharma Corporation. Speaker's Bureau; Self; Mitsubishi Tanabe Pharma Corporation. Advisory Panel; Self; Mitsubishi Tanabe Pharma Corporation. Research Support; Self; Daiichi Sankyo Company, Limited. Speaker's Bureau; Self; Daiichi Sankyo Company, Limited. Advisory Panel; Self; Daiichi Sankyo Company, Limited. Research Support; Self; Sanwa Kagaku Kenkyusho Co., Ltd.. Speaker's Bureau; Self; Sanwa Kagaku Kenkyusho Co., Ltd.. Research Support; Self; Novo Nordisk Inc.. Speaker's Bureau; Self; Novo Nordisk Inc.. Advisory Panel; Self; Novo Nordisk Inc.. Research Support; Self; Eli Lilly and Company. Speaker's Bureau; Self; Eli Lilly and Company. Advisory Panel; Self; Eli Lilly and Company. Research Support; Self; Sanofi. Speaker's Bureau; Self; Sanofi. Advisory Panel; Self; Sanofi. Research Support; Self; Sumitomo Dainippon Pharma Co., Ltd.. Speaker's Bureau; Self; Sumitomo Dainippon Pharma Co., Ltd.. Research Support; Self; Shionogi & Co., Ltd.. Speaker's Bureau; Self; Shionogi & Co., Ltd., Bayer Yakuhin, Ltd., Astellas Pharma US, Inc., AstraZeneca. Advisory Panel; Self; AstraZeneca, Teijin Pharma Limited.