PSUN241 A Case of Dulaglutide-Induced Acute Pancreatitis in a Diabetic Patient – A Case Report
Authors: Abdelmasih Randa , Saeed Zainab , Ashraf Bilal , Abdelmaseih Ramy , Nasser Hesham 
Published: November 2022

Abstract

Introduction
Dulaglutide is a glucagon-like peptide-1 (GLP-1 RA) receptor agonist that was approved by the FDA as a pharmacological treatment of diabetes management over the last decade. It is available in an injectable form that is dosed weekly which increases patients’ adherence and improves outcomes. The mechanism of action of GLP-1 RA is through regulation of blood glucose levels through glucose-dependent stimulation of insulin secretion and inhibition of glucagon release. Also, their effect on GLP-1 receptors in the CNS and the gastrointestinal tract leads to delay in gastric emptying and induces satiety. Such mechanism of action decreases the risk of hypoglycemia and facilitates weight loss. All these features make GLP-1 RA of great interest among new diabetes pharmacological options.The most frequently reported adverse effects from GLP-1 RA are gastrointestinal symptoms and injection-site pruritus. Acute pancreatitis is a rare but serious complication of GLP-1 RA use. We present a case of Dulaglutide-induced acute pancreatitis in a diabetic patient.

Case presentation
77-year-old type II diabetic male on Dulaglutide 1.5 mg weekly which was increased to 3 mg weekly 2 weeks prior to a presentation presented with epigastric pain, nausea, and vomiting for 2 days. The patient denied any previous episodes, history of gallstones or alcohol use or recent endoscopic retrograde cholangiogram. An abdominal exam revealed epigastric tenderness. Laboratory workup was remarkable for Lipase of 953, otherwise, Calcium, triglycerides, liver enzymes were within normal limit. Computed tomography scan of the abdomen confirmed pancreatitis. Right upper quadrant ultrasound showed no evidence of gallstones or biliary system dilation. Holding Dulaglutide with standard treatment for pancreatitis resulted in symptom resolution.

Discussion
GLP-1 RA-induced pancreatitis is a very serious adverse event, yet this association has not been well established in humans, especially that baseline rate of pancreatitis in diabetic patients (most population studied using GLP-1 agonist) is higher compared to the general population. Until now most available data are driven from studies on animals, case reports, and a few observed cases on studies.Pathophysiologyis not well understood. One theory is thought to be due to GLP-1 RA effect on decreasing gut motility including biliary and gallbladder, which increases the risk of gallstone formation. However, not all reported cases had history of gallstones. This leads us to the other suggested mechanism through effect of GLP-1 RA on exocrine pancreas through ductal proliferation and metaplasia which if severe, can lead to hemorrhagic pancreatitis.Hence, the GLP-1 RA use should be judicious in patients with high risk of pancreatitis, such as severe hypertriglyceridemia, alcohol intake, or prior pancreatitis history.

Conclusion
Diabetes and hypertriglyceridemia are independent risk factors of acute pancreatitis. Future studies are warranted to assess GLP-1 RA-induced pancreatitis in non-diabetic patients and to investigate its dose-dependence relationship.
Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.