Weight loss in patients with type 2 diabetes receiving once‐weekly dulaglutide plus insulin lispro or insulin glargine plus insulin lispro: A post‐hoc analysis of the AWARD‐4 study across baseline body mass index subgroups

Feb 10, 2019Diabetes, obesity & metabolism

Weight loss in type 2 diabetes patients using weekly dulaglutide with fast-acting insulin or long-acting insulin with fast-acting insulin, analyzed by starting body weight

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Abstract

Dulaglutide 1.5 mg was associated with a 3.23 kg greater weight loss compared to insulin glargine after 52 weeks.

49.0% of patients treated with dulaglutide experienced no weight gain, compared to 19.0% for insulin glargine.
21.7% of dulaglutide patients achieved weight loss of at least 3%, while only 5.7% of insulin glargine patients did.
10.5% of patients on dulaglutide achieved weight loss of at least 5%, compared to 2.4% on insulin glargine.
26.2% of patients using dulaglutide reached HbA1c levels below 7% without weight gain, in contrast to 7.9% with insulin glargine.
11.9% of dulaglutide patients achieved HbA1c <7% with at least 3% weight loss, compared to 1.4% for insulin glargine.

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AIMS: Insulin-treated patients with type 2 diabetes (T2D) and obesity are challenged in achieving body weight stability or reduction, in addition to glycaemic control. Post-hoc analyses of body weight and insulin dose data from the AWARD-4 trial involved comparison of treatment with once-weekly dulaglutide 1.5 mg (N = 295) or 0.75 mg (N = 293) and treatment with daily insulin glargine (N = 296), each with prandial insulin lispro (± metformin).

MATERIALS AND METHODS: Changes in weight and in the proportion of patients without weight gain or with weight loss of at least 3%, 5% or 10% or composites of HbA1c less than 7% without weight gain and weight loss of at least 3% after 52 weeks were compared between the dulaglutide (either dose) groups and the insulin glargine group, overall and by baseline BMI (<30, 30-<35, ≥35 kg/m), using analysis of covariance and logistic regression, including interaction terms. 2

RESULTS: The following parameters were statistically significant (P < 0.01) in favour of the dulaglutide-treated groups, at lower mean total daily insulin doses, vs the insulin glargine group. The achieved targets were more pronounced with dulaglutide 1.5 mg than with insulin glargine: LSM weight change difference, -3.23 kg; proportion of patients without weight gain, 49.0% vs 19.0%; proportion of patients with weight loss ≥3%, 21.7% vs 5.7% or with weight loss ≥5%, 10.5% vs 2.4%; proportion of patients with HbA1c <7% without weight gain, 26.2% vs 7.9%; proportion of patients with HbA1c <7% and weight loss ≥3%, 11.9% vs 1.4%, respectively. Treatment effect for these parameters was not significantly different across BMI categories.

CONCLUSIONS: Larger proportions of patients in late-stage T2D needing treatment intensification achieved glycemic control without weight gain or with weight loss at lower insulin doses with once-weekly dulaglutide plus daily prandial insulin than with a basal-bolus insulin regimen, overall and across all three BMI subgroups.

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Weight loss in patients with type 2 diabetes receiving once‐weekly dulaglutide plus insulin lispro or insulin glargine plus insulin lispro: A post‐hoc analysis of the AWARD‐4 study across baseline body mass index subgroups

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