Publications

Introduction

Glucose lowering reduces symptoms of hyperglycemia and many of the long-term complications of diabetes (1). Patient characteristics may affect the glycemic responses to various therapies (2). Glucagon-like peptide-1 (GLP-1) receptor agonists are a class of glucose-lowering drugs used to treat type 2 diabetes and include dulaglutide. Post hoc analysis of the Assessment of Weekly AdministRation of LY2189265 in Diabetes (AWARD) trials suggests that the 6-month glycemic effect of dulaglutide is independent of BMI and duration of diabetes (3–5). Whether these characteristics or the presence of microvascular disease affects glucose lowering during short- or long-term therapy remains unknown (6).

The Researching cardiovascular Events with a Weekly INcretin in Diabetes (REWIND) cardiovascular (CV) outcomes trial demonstrated that the addition of dulaglutide 1.5 mg to the standard care for type 2 diabetes and either CV risk factors or previous CV disease (CVD) reduced the hazard of a composite outcome of CV death, nonfatal myocardial infarction, or nonfatal stroke in patients with type 2 diabetes (6). During this trial, patients assigned to dulaglutide had a least-squares mean (LSM) glycated hemoglobin (HbA1c) that was 0.61% lower than patients assigned to placebo during a median follow-up period of 5.4 years (6). In addition to the CV efficacy of dulaglutide demonstrated in REWIND, HbA1c outcomes over long-term use is an important clinical consideration to help tailor therapy and further improve and manage diabetes complications. The current post hoc analysis assesses whether changes in HbA1c levels in the dulaglutide 1.5 mg group varied with diabetes duration, microvascular disease (retinopathy and/or nephropathy), or BMI, either separately or combined, and whether the rate of change in HbA1c during the first 12 months and subsequent 60 months of therapy differed in patients assigned to dulaglutide 1.5 mg versus placebo added to standard care for diabetes.