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治疗强化后按糖化血红蛋白(HbA1c)类别分层的基础和餐后高血糖的相对贡献,使用度拉糖肽。

Relative contribution of basal and postprandial hyperglycaemia stratified by HbA1c categories before and after treatment intensification with dulaglutide.

机构信息

Department of Medicine, Emory University, Atlanta, Georgia.

Department of Endocrinology, Cleveland Clinic, Cleveland, Ohio.

出版信息

Diabetes Obes Metab. 2019 Jun;21(6):1365-1372. doi: 10.1111/dom.13662. Epub 2019 Mar 18.


DOI:10.1111/dom.13662
PMID:30756511
Abstract

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.

摘要

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。

相似文献

[1]
Relative contribution of basal and postprandial hyperglycaemia stratified by HbA1c categories before and after treatment intensification with dulaglutide.

Diabetes Obes Metab. 2019-3-18

[2]
Effect of once-weekly dulaglutide versus insulin glargine in people with type 2 diabetes and different baseline glycaemic patterns: A post hoc analysis of the AWARD-2 clinical trial.

Diabetes Obes Metab. 2019-8-16

[3]
Effect of once-weekly dulaglutide on glycated haemoglobin (HbA1c) and fasting blood glucose in patient subpopulations by gender, duration of diabetes and baseline HbA1c.

Diabetes Obes Metab. 2017-10-5

[4]
Effect of once weekly dulaglutide by baseline beta-cell function in people with type 2 diabetes in the AWARD programme.

Diabetes Obes Metab. 2018-5-2

[5]
Dulaglutide versus insulin glargine in patients with type 2 diabetes and moderate-to-severe chronic kidney disease (AWARD-7): a multicentre, open-label, randomised trial.

Lancet Diabetes Endocrinol. 2018-6-14

[6]
Placebo-controlled, randomized trial of the addition of once-weekly glucagon-like peptide-1 receptor agonist dulaglutide to titrated daily insulin glargine in patients with type 2 diabetes (AWARD-9).

Diabetes Obes Metab. 2017-4-10

[7]
Efficacy and safety of subgroup analysis stratified by baseline HbA1c in a Japanese phase 3 study of dulaglutide 0.75 mg compared with insulin glargine in patients with type 2 diabetes.

Endocr J. 2017-12-28

[8]
Weight loss in patients with type 2 diabetes receiving once-weekly dulaglutide plus insulin lispro or insulin glargine plus insulin lispro: A post-hoc analysis of the AWARD-4 study across baseline body mass index subgroups.

Diabetes Obes Metab. 2019-3-15

[9]
Efficacy and Safety of Once-Weekly Dulaglutide Versus Insulin Glargine in Patients With Type 2 Diabetes on Metformin and Glimepiride (AWARD-2).

Diabetes Care. 2015-6-18

[10]
A 24-week study to evaluate the efficacy and safety of once-weekly dulaglutide added on to glimepiride in type 2 diabetes (AWARD-8).

Diabetes Obes Metab. 2016-5

引用本文的文献

[1]
Ultra rapid lispro improves postprandial glucose control versus lispro in combination with basal insulin: a study based on CGM in type 2 diabetes in China.

Front Endocrinol (Lausanne). 2024

[2]
Efficacy of Dulaglutide in Chinese Patients with Type 2 Diabetes and Different Glycemic Patterns: a Post-hoc Analysis of the Phase 3 AWARD-CHN2 Trial.

Diabetes Ther. 2022-1

[3]
A new approach for investigating the relative contribution of basal glucose and postprandial glucose to HbA1.

Nutr Diabetes. 2021-6-4

[4]
Comparative effectiveness of dulaglutide versus liraglutide in Asian type 2 diabetes patients: a multi-institutional cohort study and meta-analysis.

Cardiovasc Diabetol. 2020-10-9

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