Kazim Mehrunissa, Trivedi Nitin
AACE Clin Case Rep. 2018 Nov 1;5(2):e142-e145. doi: 10.4158/ACCR-2018-0192. eCollection 2019 Mar-Apr.
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).
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.
A 56-year-old man with T2DM, class III obesity (weight 314 pounds, body mass index 46.4 kg/m), 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.
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.
尽管有几种新型抗糖尿病药物可供使用，但很大一部分糖尿病患者仍未能实现最佳血糖控制。在基础胰岛素治疗方案中添加胰高血糖素样肽-1受体激动剂（GLP1 RAs）已显示可改善2型糖尿病（T2DM）的血糖控制。
我们报告一名T2DM患者，在将每周一次的度拉鲁肽添加到U500常规胰岛素治疗方案后，血糖控制显著改善，同时体重减轻且胰岛素需求量减少。
一名56岁的男性，患有T2DM、III级肥胖（体重314磅，体重指数46.4 kg/m）和高脂血症，尽管使用了高剂量胰岛素治疗和二甲双胍，但糖化血红蛋白（HbA1c）为9.7%（83 mmol/mol），血糖控制不佳。除肥胖外，体格检查无异常。尽管胰岛素剂量增加至每天400单位，其HbA1c仍居高不下。在其治疗方案中添加度拉鲁肽几个月后，尽管每日胰岛素剂量显著减少至20单位（减少94%），患者的HbA1c仍降至6.3%（45 mmol/mol），同时体重减轻了20磅。
该患者在接受度拉鲁肽治疗后，HbA1c、体重和胰岛素需求量均显著下降。在文献中，我们仅找到1项研究，其中15名接受U500胰岛素治疗（平均剂量197±72单位/天）的患者成功使用了GLP1 RA（利拉鲁肽）。然而，他们的体重和HbA1c降幅明显小于我们的患者。对于需要高剂量胰岛素治疗的T2DM患者，应考虑使用GLP1 RAs。
