Department of Diabetes, Endocrinology and Metabolism, Kawasaki Medical School, Kurashiki, Japan.
Front Endocrinol (Lausanne). 2021 Aug 6;12:714447. doi: 10.3389/fendo.2021.714447. eCollection 2021.
At present, daily DPP-4 inhibitors are quite frequently prescribed in subjects with type 2 diabetes mellitus (T2DM). Recently, it has been drawing much attention that once-weekly incretin-based injection dulaglutide was developed. In this study, we aimed to examine the possible effects of once-weekly GLP-1 receptor activator (GLP-1RA) dulaglutide on glycemic control as well as various metabolic parameters.
We made a direct comparison between the effect of daily DPP-4 inhibitor and once-weekly dulaglutide on glycemic control in "study 1 (pre-post comparison)" and set the control group using the propensity score matching method in "study 2".
In study 1, switching from daily DPP-4 inhibitor to dulaglutide significantly ameliorated glycemic control in subjects with T2DM. Such effects were more obvious in poorly controlled subjects. After 1:1 propensity score matching, the switching group improved glycemic control compared with the non-switching group in study 2.
We should bear in mind that switching from daily DPP-4 inhibitor to once-weekly GLP-1RA dulaglutide exerts more favorable effects on glycemic control regardless of age, body weight, and duration of diabetes in subjects with T2DM, especially when we fail to obtain good glycemic control with daily DPP-4 inhibitor.
目前，二型糖尿病（T2DM）患者常每日服用二肽基肽酶-4 抑制剂（DPP-4i）。最近，每周一次的肠促胰岛素类似物度拉鲁肽备受关注。本研究旨在探讨每周一次的胰高血糖素样肽-1 受体激动剂（GLP-1RA）度拉鲁肽对血糖控制及多种代谢参数的可能影响。
在“研究 1（前后比较）”中，我们直接比较了每日 DPP-4i 与每周一次度拉鲁肽对 T2DM 患者血糖控制的影响，并在“研究 2”中采用倾向评分匹配法设置对照组。
在研究 1 中，从每日 DPP-4i 换用度拉鲁肽可显著改善 T2DM 患者的血糖控制。在血糖控制较差的患者中，效果更为明显。在进行 1:1 倾向评分匹配后，研究 2 中的转换组在血糖控制方面优于非转换组。
我们应该记住，与每日 DPP-4i 相比，无论 T2DM 患者的年龄、体重和糖尿病病程如何，转换为每周一次的 GLP-1RA 度拉鲁肽对血糖控制的影响更为有利，尤其是当我们无法通过每日 DPP-4i 获得良好的血糖控制时。
