Abbreviations: (ANCOVA) analysis of covariance, (AUCH) glucose area >140 mg% normalized to 7 days of the continuous glucose sensor download, (AUCL) glucose area <70 mg% normalized to 7 days of the continuous glucose sensor download, (BAS) basal insulin dose as a percentage of the total daily insulin dose, (BG) weekly mean glucose level, (BOL) number of daily boluses, (CEEGI) Central and Eastern Europe, Greece, and Israel, (CGS) continuous glucose sensing, (DCCT) Diabetes Control and Complications Trial, (GHb) glycosylated hemoglobin, (HEX) number of glucose excursions above 140 mg%, (IFCC) International Federation of Clinical Chemistry and Laboratory Medicine, (INS) total daily insulin dose, (LEX) number of glucose excursions below 70 mg%, (MANOVA) multivariate analysis of variance, (SD) standard deviation, (SDEV) standard deviation glucose

Aims: Dulaglutide, a once weekly GLP-1 receptor agonist, is approved at two doses (1.5 and 0.75 mg) for treatment of type 2 diabetes (T2D). Two higher doses of dulaglutide (3.0 and 4.5 mg) were evaluated for safety and efficacy to determine whether these doses warrant further study for improved control of glucose and body weight.Materials and methods: This 18-week, double-blind, phase 2 trial randomized 318 patients with T2D using ≥1500 mg metformin, to receive subcutaneous injection of placebo (n = 82), dulaglutide 1.5 mg (n = 81), dulaglutide 3.0 mg (n = 79) or dulaglutide 4.5 mg (n = 76). The primary objective was superiority of dulaglutide doses over placebo in reduction of HbA1c at 18 weeks. Secondary objectives included superiority of dulaglutide over placebo in change from baseline in body weight and fasting serum glucose (FSG) at 18 weeks. Investigational doses of dulaglutide were compared to the 1.5 mg dose as an exploratory objective. Results: HbA1c reduction at 18 weeks was significantly greater with dulaglutide vs placebo (placebo, −0.44% ± 0.10% [−4.8 ± 1.1 mmol/mol]; dulaglutide 1.5 mg, −1.23% ± 0.10% [−13.5 ± 1.1 mmol/mol]; dulaglutide 3.0 mg, −1.31% ± 0.10% [−14.3 ± 1.1 mmol/mol]; dulaglutide 4.5 mg, −1.40% ± 0.10% [−15.3 ± 1.1 mmol/mol]; P < 0.001, each dose), as were changes in body weight (placebo, −1.6 ± 0.39 kg; dulaglutide 1.5 mg, −2.8 ± 0.39 kg; dulaglutide 3.0 mg, −3.9 ± 0.39 kg; dulaglutide 4.5 mg, −4.1 ± 0.41 kg; P < 0.001, each dose). All three dulaglutide doses significantly reduced FSG from baseline (1.5 mg, −36.2 ± 4.7 mg/dL [−2.0 ± 0.3 mmol/L]; 3.0 mg, −34.5 ± 4.5 mg/dL [−1.9 ± 0.3 mmol/L]; 4.5 mg, −38.0 ± 4.7 mg/dL [−2.1 ± 0.3 mmol/L]) vs placebo (−12.4 ± 4.5 mg/dL [−0.7 ± 0.3 mmol/L]) (P < 0.001, all). Safety profiles of the higher doses were consistent with the established safety profile for dulaglutide. Gastrointestinal events were mostly mild to moderate, and was dose-related for nausea.Conclusion: All three dulaglutide doses were superior to placebo in improving glycaemic control and reducing body weight in participants with T2D using metformin. The potential for doses of dulaglutide of 3.0 and 4.5 mg to provide additional

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Cost analysis indicated that SMBG provides a rapid return on initial investment. By increasing the number of patients using SMBG, the statutory health insurance system in the Czech Republic may save several million CZK annually.

In this article the pregnancy of a woman suffering from the complete triad typical of Autoimmune Polyglandular Syndrome Type 2 (Addison's disease + type 1 diabetes + Hashimoto's thyroiditis) is reported. By using insulin pump therapy with insulin lispro, it was possible to balance diabetes control with changes of steroid replacement therapy. Pregnancy was uneventful until week 27, when signs of preeclampsia occurred. The boy was born without difficulty at gestational age 37 weeks by planned cesarean section but signs of diabetic fetopathy (macrosomia, hypoglycaemia and hypocalcaemia) were expressed. He required a short course of hydrocortisone therapy. He made a good and rapid recovery. The mother made a good post-operative recovery too, but 4 months after the delivery microalbuminuria as well as mild hyperuricemia are still present. Interdisciplinary approach and very careful observation of the mother as well as of the child enabled successful outcome of this highly risky pregnancy.