Is dulaglutide more effective than insulin glargine for patients with type 2 diabetes?

This article looked at the effectiveness of dulaglutide (Trulicity) compared to insulin glargine (Lantus) for patients with uncontrolled type 2 diabetes (T2D). This study concluded that dulaglutide is more effective for these patients compared to insulin glargine.

Metformin is recommended as a first-line treatment for patients with T2D. However, most patients eventually require second-line medications for better blood glucose control. Many patients also have additional medical conditions, such as heart disease, which can make diabetes management difficult.

Patients with T2D are also at risk for low blood glucose levels (hypoglycemia). Long term use of insulin can increase this risk. Dulaglutide helps the pancreas release the right amount of insulin when blood glucose levels are high. This helps lower blood glucose levels. Whether dulaglutide is more effective than insulin glargine for patients with T2D is unclear.

535 patients with uncontrolled T2D were included in this study. 237 patients received dulaglutide, and 262 patients received insulin glargine. Patients were already taking metformin (Glucophage) and glimepiride (Amaryl). Patients were followed up for 26 weeks. Blood glucose levels before eating in the morning (fasting levels) were measured. HbA1c levels (average blood glucose levels over the past 3 months) were also measured.

After 4 weeks of treatment, patients treated with dulaglutide were 1.78 times more likely to have lower fasting blood glucose levels (less than 7.2 mmol/L or less than 130 mg/dL). More patients in the dulaglutide group reached this target level compared to insulin glargine (58.7% vs. 48.2%). After 26 weeks, significantly more patients in the dulaglutide group reached this target level compared to insulin glargine (37.4% vs. 10.3%).

After 20 weeks of treatment, patients in the dulaglutide group had significantly fewer episodes of low blood glucose per week compared to the insulin glargine group (0.11 episodes vs. 0.23 episodes). One patient in each group had an episode of serious low blood glucose during the first 20 weeks of treatment.

At 26 weeks, patients in the dulaglutide group were 6.76 times more likely to have HbA1c levels less than 7.0%, no low blood glucose episodes, and no weight gain. 

This study concluded that dulaglutide is more effective for patients with T2D compared to insulin glargine. The authors suggest that the benefits of dulaglutide are clear soon after starting treatment and after 6 months of therapy.

This study was funded by Eli Lilly, the manufacturer of dulaglutide. Eli Lilly was also involved in data collection and analysis.