Real-World Effectiveness of Dulaglutide in Patients with Type 2 Diabetes Mellitus: A Literature Review

Abstract

Introduction: Randomized controlled trials (RCTs) have demonstrated the efficacy of dulaglutide in adults with type 2 diabetes mellitus (T2DM), but results may not be generalizable in routine practice. This pragmatic literature review aimed to summarize real-world evidence (RWE) for dulaglutide. Methods: The MEDLINE, EMBASE, NHS Economic Evaluation Database, and Health Technology Assessment databases were searched from January 2014 to July 2019 for studies providing RWE for dulaglutide in adults with T2DM regarding at least one outcome of interest (change in glycated hemoglobin [HbA1c]; weight; adherence; persistence; discontinuation; costs; healthcare resource utilization; health-related quality of life; patient satisfaction; and preference). Relevant congress abstracts were identified from EMBASE. Results: A total of 29 studies (11 articles; 18 abstracts) were included. RWE for dulaglutide was not identified for all outcomes of interest. Dulaglutide reduced HbA1c from baseline to 3-24 months by 0.5-2.2% across studies (n = 20), and 23.4-55.7% of patients achieved HbA1c \ 7.0%. Weight was reduced by 2.1-6.4 kg across studies of 3-12 months (n = 15). Based on outcomes from ten studies, 27.2-61.0% of dulaglutide patients were adherent. Mean persistence was 146-152 days and [ 250 days in 6-and 12-month studies, respectively. Most studies reported discontinuation rates of 26.2-37.0%. Adherence and persistence were consistently reported to be greater in dulaglutide-treated patients in RW settings compared with other glucagon-like peptide-1 receptor agonists. Dulaglutide was associated with lower costs per 1% reduction in HbA1c compared with exenatide, liraglutide, or basal insulin (n = 3 studies). Conclusion: Evidence from RWE studies suggests that dulaglutide may be associated with clinically relevant reductions in HbA1c, with a Digital Features To view digital features for this article go to

Immediate Glucose-Lowering Effect After the First Administration of Dulaglutide: A Retrospective, Single-Center, Observational Study

“…In the AWARD-3 trial, although there was no difference in the overall degree of treatment satisfaction between the dulaglutide and metformin arm, a significantly greater reduction in the perceived frequency of hyperglycemia was observed in the dulaglutide arm at 52 weeks [11]. An observational study showed greater adherence to and persistence with dulaglutide treatment as compared to twicedaily or weekly exenatide, lixisenatide, or liraglutide treatment [12]. Similar results were reported from comparisons with semaglutide and weekly exenatide [13].…”

HbA1c Reduction in Dulaglutide-Treated Patients Irrespective of Duration of Diabetes, Microvascular Disease, and BMI: A Post Hoc Analysis From the REWIND Trial

“…In addition, it is limited by the fact that HbA 1c levels were not concealed and investigators used a variety of different glucoselowering agents (other than GLP-1 receptor agonists) to control HbA 1c levels according to their best judgment and not according to a protocol-defined target. In the REWIND study, treatment adherence to dulaglutide exceeded that of real-world observations, although real-world studies on adherence to dulaglutide had shorter follow-ups (25,26). Drop-in antihyperglycemic therapies clearly could have had an effect on the change in HbA 1c from baseline, but the reverse may also be true, as change in HbA 1c could have an effect on the introduction of drop-in therapies at different time points in both treatment groups; therefore, an analysis on the impact of drop-in therapies on the change in HbA 1c is not presented as there is no clear assignment of response and predictor variables in this case.…”

Individualized HbA1c Goals, and Patient Awareness and Attainment of Goals in Type 2 Diabetes Mellitus: A Real-World Multinational Survey

“…Guidelines also recommend that HbA 1c goals are individualized on the basis of patient characteristics, patient preferences and goals, and risk of treatment-related adverse effects such as hypoglycemia and weight gain [ 1 , 2 ]. Previous real-world studies have focused on the prevalence of adults with type 2 diabetes mellitus achieving an HbA 1c goal of < 7.0% despite the recommended individualization of glycemic goals [ 9 – 14 ].…”