Treatment effects of once-weekly dulaglutide versus insulin glargine in patients with different baseline glycemic patterns (based on high/low fasting or high/low postprandial glucose): A post hoc analysis of the AWARD-2 clinical trial

Introduction:

Insulin glargine (Glar) exerts its action by decreasing fasting plasma glucose (FPG), whereas dulaglutide (DU), a once-weekly GLP-1RA, targets fasting and postprandial glucose (PPG).

Methods:

AWARD-2 post-hoc analysis assessed efficacy of DU vs. Glar in Type 2 diabetes patients with different glycemic patterns at baseline determined by self-monitoring of blood glucose (fasting glucose [FG] vs. PPG) using analysis of covariance.

Results:

Patients were categorized into 4 groups based on combinations of low and high FG and PPG. Median baseline values of FG (151 mg/dL) and PPG (182 mg/dL) were used as threshold for low and high, respectively. DU showed a statistically significantly greater A1c reduction compared with Glar for all subgroups [Low FG-Low PPG: -0.6% (DU) and -0.2% (Glar), p < 0.01; High FG- Low PPG: -1.0% (DU) and -0.5% (Glar), p < 0.05; High FG-High PPG: -1.4%(DU) and -0.9%(Glar), p < 0.01], except for low FG/high PPG, where the numerical difference was in favor of DU (DU: -0.9%, Glar: -0.5%) but did not reach statistical significance. DU resulted in a greater reduction in weight compared with Glar, whereas Glar increased weight among patients with different glycemic pattern. Total hypoglycemia was numerically lower for DU vs. Glar in all subgroups.

Conclusion:

DU showed efficacy on A1c reductions across different baseline glycemic patterns vs. Glar (with the exception of low FG/high PPG), indicating a clinical benefit of targeting both FG and PPG, irrespective of the baseline glycemic phenotype.