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Dulaglutide as effective as insulin glargine in diabetes with CKD : Lancet


Dulaglutide as effective as insulin glargine in diabetes with CKD : Lancet

In patients with type 2 diabetes (T2D) and moderate-to-severe chronic kidney disease (CKD), treatment with dulaglutide produced glycaemic control similar to that of insulin glargine, with a reduced decline in estimated glomerular filtration rate (eGFR). This is finding of the AWARD-7 study published in the journal The Lancet Diabetes & Endocrinology. 

Katherine R. Tuttle, Providence Health Care, University of Washington, Spokane, WA, USA, and colleagues to assess the efficacy and safety of dulaglutide in patients with type 2 diabetes and moderate-to-severe chronic kidney disease.

Dulaglutide, a glucagon-like peptide 1 receptor agonist consists of GLP-1 covalently linked to an Fc fragment of human IgG4. It is used for the treatment of T2D and can be used once weekly.

For the study, eligible patients (N=577) were randomized to receive dulaglutide 1.5mg once-weekly , dulaglutide 0.75mg (N=190) once-weekly, or insulin glargine daily , all in combination with insulin lispro, for 52 weeks. HbA1c at 26 weeks with a 0.4% non-inferiority margin was designated as the primary outcome, while secondary outcomes included eGFR and urine albumin-to-creatinine ratio.

Key Findings:

  • At 26 weeks, dulaglutide was found to be non-inferior to insulin glargine in its effects on HbA1c.
  • At 52 weeks, eGFR was higher with dulaglutide 1·5 mg and dulaglutide 0·75 mg than with insulin glargine.
  • At 52 weeks, the effects of dulaglutide 1·5 mg and 0·75 mg on UACR reduction were not significantly different from that of insulin glargine.
  • Proportions of patients with any serious adverse events were similar across groups, 20%  with dulaglutide 1·5 mg, 24%  with dulaglutide 0·75 mg, and 27% with insulin glargine).
  • Dulaglutide was associated with higher rates of nausea (20% with dulaglutide 1·5 mg and 14% with 0·75 mg, vs 5%  with insulin glargine) and diarrhoea (17% with dulaglutide 1·5 mg and 16% with 0·75 mg, vs 7% with insulin glargine) and lower rates of symptomatic hypoglycaemia.
  • End-stage renal disease occurred in 38 participants: 4% with dulaglutide 1·5 mg, 7% with dulaglutide 0·75 mg, and 8% with insulin glargine.

Based on the findings, the authors concluded that in patients with type 2 diabetes and moderate-to-severe chronic kidney disease, once-weekly dulaglutide produced glycaemic control similar to that achieved with insulin glargine, with reduced decline in eGFR. Dulaglutide seems to be safe to use to achieve glycaemic control in patients with moderate-to-severe chronic kidney disease.

For more information click on the link: https://doi.org/10.1016/S2213-8587(18)30104-9


Source: With inputs from The Lancet Diabetes & Endocrinology

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