Diabetes, obesity & metabolismAug 1, 2019

Once-weekly dulaglutide versus insulin glargine in type 2 diabetes with different starting blood sugar patterns

GLP-1 Therapies Weekly Brief ↗PubMed ↗DOI ↗OA ↗

Updated Apr 6, 2026

Abstract

At 52 weeks, significant reductions in glycated hemoglobin () were observed with dulaglutide 1.5 mg in all glycaemic subgroups except for those with low fasting glucose and low postprandial glucose receiving insulin glargine.

Dulaglutide stimulates insulin secretion and reduces glucagon levels in a glucose-dependent manner.
Basal insulin primarily reduces elevated fasting glucose by inhibiting liver glucose production.
Participants were categorized into four subgroups based on baseline fasting and postprandial glucose levels.
All subgroups treated with dulaglutide and glargine showed significant HbA1c reductions, except the low FG/low PPG group on glargine.
Dulaglutide resulted in greater HbA1c reductions compared to glargine across most subgroups.

Simplified

The long-acting glucagon-like peptide-1 receptor agonist dulaglutide acts by stimulating insulin secretion and reducing glucagon levels in a glucose-dependent manner both in the fasting and postprandial states, resulting in reductions of both fasting glucose (FG) and postprandial glucose (PPG). In contrast, the main mechanism of action of basal insulin is to reduce elevated FG by inhibiting hepatic glucose production. The aim of the present post hoc analysis of the phase 3 AWARD-2 trial was to investigate whether specific baseline glycaemic patterns respond differentially to dulaglutide compared to insulin glargine (glargine). We categorized participants into four subgroups based on prespecified glucose thresholds and their baseline FG and daily 2-hour mean PPG: low FG/low PPG; low FG/high PPG; high FG/low PPG; and high FG/high PPG. Changes in glycaemic measures in response to treatment with dulaglutide or glargine were evaluated in each subgroup. At 52 weeks, significant reductions from baseline in glycated haemoglobin () were observed in all subgroups with dulaglutide 1.5 mg and with glargine (all P < .05), except in patients with low FG/low PPG who received glargine. Greater HbA1c reductions were observed with dulaglutide 1.5 mg compared to glargine in all subgroups (all P ≤ .05), except in the low FG/high PPG subgroup.

Key numbers

−1.4%

Reduction

Change from baseline in at 52 weeks for dulaglutide 1.5 mg.

−4.5 kg

Body Weight Change

Change from baseline in body weight for dulaglutide in the low FG/high PPG subgroup.

766

Participants Included

Total number of participants in the post hoc analysis.

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Funding

Competing interests

F.G. serves or has served on the advisory boards for AstraZeneca, Eli Lilly and Company, Roche Diabetes Care, and NovoNordisk, serves or has served as a consultant for AstraZeneca, Boehringer‐Ingelheim, Lifescan, Merck Sharp & Dohme and Sanofi, and has received research support from AstraZeneca, Eli Lilly and Company, Lifescan and Takeda. M.Y., Z.M., A.H. and L.E.G.P. are employees and shareholders of Eli Lilly and Company. Partial data from this study have been previously presented at the American Diabetes Association 78 th Annual Scientific Sessions, held in Orlando, Florida, June 22–26, 2018, and at the 54th Annual Meeting of the European Association for the Study of Diabetes, held in Berlin, Germany, October 1–5, 2018.

PubMed

Once-weekly dulaglutide versus insulin glargine in type 2 diabetes with different starting blood sugar patterns

Abstract

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Funding

Competing interests

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Abstract

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Related papers

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