Background and Aims: There are currently nine categories of hypoglycemic drugs and the range of choice is expanding. Insulin is very effective but prone to hypoglycemia. Therefore, it is important to consider changing to drugs that are unlikely to cause hypoglycemia in patients who have stable glycemic status. At the same time, however, it should be noted that inappropriate de-escalation of treatment leads to a worsening of the glycemic situation. Thus, in patients with T2D treated with Basal-Bolus Therapy (BBT) using a small amount of bolus insulin and stable glycemic control, under CGM, we had left basal insulin and switched from all bolus insulin to a weekly GLP-1 RA.

Materials and Methods: The subjects were T2D outpatients who were changed from BBT to Basal-GLP-1 RA Therapy (BGT) under CGM during the period from November 2018 to November 2019. Freestyle Libre Pro was used as CGM in all cases. We analyzed average glucose levels, glycemic variability (%CV), Time Below Range (<70mg/dl), Time In Range (70-180 mg/dl) for 3 days before and after treatment change. A total of 18 patients were included in this study. On average, the patient group was aged 58 years and they had been living with T2D for the past 7.0 years. Their HbA1c was 6.6% and BMI was 25.9 kg/m2. Non-fasting CPR was 2.9 ng/ml. Total daily bolus insulin dose was 12.6 units.

Results: In all cases, bolus insulin was changed to dulaglutide 0.75mg with the same amount of basal insulin. There was no deterioration in mean glucose levels, TBR and TIR (115.4 vs. 105.7 mg/dl, 8.2 vs. 7.5%, 81.4 vs. 87.6%, respectively). %CV (21.1 vs. 15.7%; P = 0.029) and HbA1c (6.6 vs. 6.3%; P = 0.020) were significantly improved.

Conclusion: In T2D with stable glycemic status and maintained endogenous insulin secretion, stepping down from BBT using a small amount of bolus insulin to BGT was able to better manage glycemic level and variability under CGM observation.


A. Miyoshi: None. S. Obara: None. N. Wada: None.

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