Addition of Dulaglutide for a High-Dose Insulin Requiring Patient with Type 2 Diabetes Mellitus: A Remarkable Response
ABSTRACT: Objective: Despite the availability of several new classes of antidiabetic medications, a large proportion of patients with diabetes mellitus fail to achieve optimal glycemic control. Adding glucagon-like peptide-1 receptor agonists (GLP1 RAs) to basal insulin regimens has shown to improve...
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| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2019-03-01
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| Series: | AACE Clinical Case Reports |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2376060520305071 |
| _version_ | 1818415680608796672 |
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| author | Mehrunissa Kazim, MD Nitin Trivedi, MD, FACE, FACP |
| author_facet | Mehrunissa Kazim, MD Nitin Trivedi, MD, FACE, FACP |
| author_sort | Mehrunissa Kazim, MD |
| collection | DOAJ |
| description | ABSTRACT: Objective: Despite the availability of several new classes of antidiabetic medications, a large proportion of patients with diabetes mellitus fail to achieve optimal glycemic control. Adding glucagon-like peptide-1 receptor agonists (GLP1 RAs) to basal insulin regimens has shown to improve glycemic control in type 2 diabetes mellitus (T2DM).Methods: We present a patient with T2DM who had marked improvement in glycemic control accompanied by weight loss and a decrease in insulin requirement after adding weekly dulaglutide to U500 regular insulin.Results: A 56-year-old man with T2DM, class III obesity (weight 314 pounds, body mass index 46.4 kg/m2), and hyperlipidemia had uncontrolled glycemia with a hemoglobin A1c (HbA1c) of 9.7% (83 mmol/mol) despite using high-dose insulin therapy and metformin. Physical examination was unremarkable except for obesity. His HbA1c remained high despite increments in insulin dosage up to 400 units per day. A few months after adding dulaglutide to his regimen, the patient's HbA1c declined to 6.3% (45 mmol/mol) despite significant reduction in daily insulin dosage to 20 units (94% decrease), which was accompanied by a 20-pound weight loss.Conclusion: The patient had a dramatic decrease in HbA1c, weight, and insulin requirement after treatment with dulaglutide. In the literature we could only find 1 study where a GLP1 RA (liraglutide) was successfully used in 15 patients receiving U500 insulin (average dose 197 ± 72 units/day). However, their reductions in weight and HbA1c were markedly less than observed in our patient. GLP1 RAs should be considered in patients with T2DM who require high-dose insulin therapy.Abbreviations: AWARD-9 = study of dulaglutide (LY2189265) in participants with type II diabetes; DM = diabetes mellitus; GLP1 RA = glucagon-like peptide-1 receptor agonist; HbA1c = hemoglobin A1c; T2DM = type 2 diabetes mellitus |
| first_indexed | 2024-12-14T11:38:51Z |
| format | Article |
| id | doaj.art-b2bfa567185d40a08fb079b556c05e99 |
| institution | Directory Open Access Journal |
| issn | 2376-0605 |
| language | English |
| last_indexed | 2024-12-14T11:38:51Z |
| publishDate | 2019-03-01 |
| publisher | Elsevier |
| record_format | Article |
| series | AACE Clinical Case Reports |
| spelling | doaj.art-b2bfa567185d40a08fb079b556c05e992022-12-21T23:02:55ZengElsevierAACE Clinical Case Reports2376-06052019-03-0152e142e145Addition of Dulaglutide for a High-Dose Insulin Requiring Patient with Type 2 Diabetes Mellitus: A Remarkable ResponseMehrunissa Kazim, MD0Nitin Trivedi, MD, FACE, FACP1From the Division of Endocrinology, Department of Medicine, Saint Vincent Hospital, Worcester, Massachusetts.Address correspondence to Dr. Nitin Trivedi, Division of Endocrinology, Department of Medicine, Saint Vincent Hospital, 123 Summer Street, Worcester, MA 01608.; From the Division of Endocrinology, Department of Medicine, Saint Vincent Hospital, Worcester, Massachusetts.ABSTRACT: Objective: Despite the availability of several new classes of antidiabetic medications, a large proportion of patients with diabetes mellitus fail to achieve optimal glycemic control. Adding glucagon-like peptide-1 receptor agonists (GLP1 RAs) to basal insulin regimens has shown to improve glycemic control in type 2 diabetes mellitus (T2DM).Methods: We present a patient with T2DM who had marked improvement in glycemic control accompanied by weight loss and a decrease in insulin requirement after adding weekly dulaglutide to U500 regular insulin.Results: A 56-year-old man with T2DM, class III obesity (weight 314 pounds, body mass index 46.4 kg/m2), and hyperlipidemia had uncontrolled glycemia with a hemoglobin A1c (HbA1c) of 9.7% (83 mmol/mol) despite using high-dose insulin therapy and metformin. Physical examination was unremarkable except for obesity. His HbA1c remained high despite increments in insulin dosage up to 400 units per day. A few months after adding dulaglutide to his regimen, the patient's HbA1c declined to 6.3% (45 mmol/mol) despite significant reduction in daily insulin dosage to 20 units (94% decrease), which was accompanied by a 20-pound weight loss.Conclusion: The patient had a dramatic decrease in HbA1c, weight, and insulin requirement after treatment with dulaglutide. In the literature we could only find 1 study where a GLP1 RA (liraglutide) was successfully used in 15 patients receiving U500 insulin (average dose 197 ± 72 units/day). However, their reductions in weight and HbA1c were markedly less than observed in our patient. GLP1 RAs should be considered in patients with T2DM who require high-dose insulin therapy.Abbreviations: AWARD-9 = study of dulaglutide (LY2189265) in participants with type II diabetes; DM = diabetes mellitus; GLP1 RA = glucagon-like peptide-1 receptor agonist; HbA1c = hemoglobin A1c; T2DM = type 2 diabetes mellitushttp://www.sciencedirect.com/science/article/pii/S2376060520305071 |
| spellingShingle | Mehrunissa Kazim, MD Nitin Trivedi, MD, FACE, FACP Addition of Dulaglutide for a High-Dose Insulin Requiring Patient with Type 2 Diabetes Mellitus: A Remarkable Response AACE Clinical Case Reports |
| title | Addition of Dulaglutide for a High-Dose Insulin Requiring Patient with Type 2 Diabetes Mellitus: A Remarkable Response |
| title_full | Addition of Dulaglutide for a High-Dose Insulin Requiring Patient with Type 2 Diabetes Mellitus: A Remarkable Response |
| title_fullStr | Addition of Dulaglutide for a High-Dose Insulin Requiring Patient with Type 2 Diabetes Mellitus: A Remarkable Response |
| title_full_unstemmed | Addition of Dulaglutide for a High-Dose Insulin Requiring Patient with Type 2 Diabetes Mellitus: A Remarkable Response |
| title_short | Addition of Dulaglutide for a High-Dose Insulin Requiring Patient with Type 2 Diabetes Mellitus: A Remarkable Response |
| title_sort | addition of dulaglutide for a high dose insulin requiring patient with type 2 diabetes mellitus a remarkable response |
| url | http://www.sciencedirect.com/science/article/pii/S2376060520305071 |
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