Objective: To assess the effect of the addition of a weekly GLP-1 Receptor Agonist, injection Dulaglutide (DU) 1.5mg in obese T2D patients, sub-optimally controlled on titrated basal insulin Glargine (iGL), prandial insulin (iP), metformin and glimepiride (SU).

Methods: We retrospectively observed the impact of addition of DU in 167 patients with HbA1c ≥ 8% for ≥ 16 weeks (wk), all on titrated iGL and also on metformin (n=156; 1.5-2g/d), SU (n=101; 3-4mg/d) and iP (n=75; 10-14 units/d). End points were changes in (i) HbA1c (ii) body weight (iii) doses of iGL and iP (iv) dose of SU at wk 16, 32 and 52. Adverse events and side effects of the combination of DU and iGL were noted.

Results: One hundred sixty-seven patients (89M/78F, age 50±4.5 years, wt.82.8±1.4 kg, BMI 30.1±2.1kg/m2, eGFR 78±4mL/min./1.73m2, 10.3±1.1 years duration of T2D) met the inclusion criteria. After addition of DU, HbA1c was - 1.23% [8.24±0.3 to 7.01±0.2, P<0.0001] at wk 16 in 74 % patients, which decreased to 6.9±0.3% (P=0.1586) in 16% at wk 32, but rose to 7.1±0.1% (P=0.1885) in 10% at wk 42-52. At wk 16, weight was - 2.3 kg (82.8±1.4 to 80.5±1.6, P<0.0001) in 78% patients with a further loss of 1.1±0.7 kg (P<0.0001) in 12% by wk 32, but was stable in others until wk 52. Dose of iGL was - 11.1 units (41.3±10.2 to 30.2±9.1, P=0.0381) in 65% subjects by wk 32, was stable in 28% but rose by 4.1±0.01 units (P=0.0078) in 7% by wk 52. Dose of iP was -5.9±0.03 units (12.5±0.3 to 6.6±0.2, P=0.9700) in 31% patients. Dose of SU had to be reduced by 60% in 75% patients and had to be stopped in others because of minor hypoglycemia. No major hypoglycemia occurred. Side effects with DU were nausea (16.5%), vomiting (15.9%) and diarrhea (6.8%), but none had to stop therapy.

Conclusion: Weekly DU when added to iGL, provides statistically significant glycemic control with weight loss, reduced hypoglycemia risk and insulin doses. This combination therapy is well tolerated.


A. Nigam: Advisory Panel; Self; Intas Pharmaceuticals Ltd., Lupin Pharmaceuticals, Inc., Sun Pharmaceutical Industries Ltd., Torrent Pharmaceuticals, USV Private Limited. Speaker’s Bureau; Self; AstraZeneca, Biocon, Cipla Inc., Eli Lilly and Company, Janssen Pharmaceuticals, Inc., Merck Sharp & Dohme Corp., Novartis Pharmaceuticals Corporation, Novo Nordisk Inc., Sanofi.

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