Department of Medicine, Emory University, Atlanta, Georgia.
Department of Endocrinology, Cleveland Clinic, Cleveland, Ohio.
Diabetes Obes Metab. 2019 Jun;21(6):1365-1372. doi: 10.1111/dom.13662. Epub 2019 Mar 18.
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 ) [(mean ± SE) -466.31 ± 18.32 mgh/dL (P < 0.001)], BHG (AUC ) [(mean ± SE) -371.46 ± 16.36 mgh/dL (P < 0.001)] and PPHG (AUC ) [(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.
目的:评估度拉糖肽对 2 型糖尿病患者不同糖化血红蛋白(HbA1c)水平下,整体高血糖中基础高血糖(BHG)和餐后高血糖(PPHG)相对贡献的影响。
方法:汇总五项 3 期研究(N=673)的数据,评估在强化治疗 6 个月后,2 型糖尿病患者接受度拉糖肽 1.5 mg 单药治疗或联合 1 种或 2 种口服药物治疗时,不同 HbA1c 类别下 BHG 和 PPHG 对整体高血糖的相对贡献变化。通过 7 点自我监测血浆葡萄糖浓度曲线下面积(AUC)计算 BHG 和 PPHG。作为次要目标,在 6 个月时通过个体研究评估度拉糖肽相对于利拉鲁肽、艾塞那肽 BID 和甘精胰岛素的 BHG 和 PPHG 的相对贡献。
结果:汇总数据显示,在接受度拉糖肽 1.5 mg 强化治疗 6 个月后,整体高血糖(AUC)[(均值±SE)-466.31±18.32 mgh/dL(P<0.001)]、BHG(AUC)[(均值±SE)-371.46±16.36 mgh/dL(P<0.001)]和 PPHG(AUC)[(均值±SE)-94.84±7.97 mg*h/dL(P<0.001)]均较基线显著降低。在基线时,随着 HbA1c 水平的升高,BHG 的相对贡献增加,PPHG 降低。这种模式在 6 个月时保持不变,尽管整体血糖随着 HbA1c 值的降低而改善。
结论:在 2 型糖尿病患者中,度拉糖肽通过降低基础和餐后高血糖来降低 HbA1c,且这种效果在各种 HbA1c 水平下均存在。