Introduction:
Insulin glargine (Glar) exerts its action by decreasing fasting plasma glucose (FPG),
whereas dulaglutide (DU), a once-weekly GLP-1RA, targets fasting and postprandial
glucose (PPG).
Methods:
AWARD-2 post-hoc analysis assessed efficacy of DU vs. Glar in Type 2 diabetes patients
with different glycemic patterns at baseline determined by self-monitoring of blood
glucose (fasting glucose [FG] vs. PPG) using analysis of covariance.
Results:
Patients were categorized into 4 groups based on combinations of low and high FG and
PPG. Median baseline values of FG (151 mg/dL) and PPG (182 mg/dL) were used as threshold
for low and high, respectively. DU showed a statistically significantly greater A1c
reduction compared with Glar for all subgroups [Low FG-Low PPG: -0.6% (DU) and -0.2%
(Glar), p < 0.01; High FG- Low PPG: -1.0% (DU) and -0.5% (Glar), p < 0.05; High FG-High
PPG: -1.4%(DU) and -0.9%(Glar), p < 0.01], except for low FG/high PPG, where the numerical
difference was in favor of DU (DU: -0.9%, Glar: -0.5%) but did not reach statistical
significance. DU resulted in a greater reduction in weight compared with Glar, whereas
Glar increased weight among patients with different glycemic pattern. Total hypoglycemia
was numerically lower for DU vs. Glar in all subgroups.
Conclusion:
DU showed efficacy on A1c reductions across different baseline glycemic patterns vs.
Glar (with the exception of low FG/high PPG), indicating a clinical benefit of targeting
both FG and PPG, irrespective of the baseline glycemic phenotype.
