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Short Communication
Drug/Regimen Dulaglutide as an Effective Replacement for Prandial Insulin in Kidney Transplant Recipients with Type 2 Diabetes Mellitus: A Retrospective Review
Hwi Seung Kim1,2*orcid, Jiwoo Lee1,2*orcid, Chang Hee Jung1,2, Joong-Yeol Park1,2, Woo Je Lee1,2orcidcorresp_icon
Diabetes & Metabolism Journal 2021;45(6):948-953.
DOI: https://doi.org/10.4093/dmj.2020.0180
Published online: February 5, 2021
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1Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea

2Asan Diabetes Center, Asan Medical Center, Seoul, Korea

corresp_icon Corresponding author: Woo Je Lee, orcid , Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea E-mail: lwjatlas@gmail.com
*Hwi Seung Kim and Jiwoo Lee contributed equally to this study as first authors.
• Received: July 23, 2020   • Accepted: November 11, 2020

Copyright © 2021 Korean Diabetes Association

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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  • Dulaglutide, a weekly injectable glucagon-like peptide-1 receptor agonist, has demonstrated effectiveness when combined with basal insulin. We examined whether the efficacy of dulaglutide is comparable to that of prandial insulin in kidney transplant (KT) recipients with type 2 diabetes mellitus (T2DM) undergoing multiple daily insulin injection (MDI) therapy. Thirty-seven patients, who switched from MDI therapy to basal insulin and dulaglutide, were retrospectively analyzed. Changes in glycosylated hemoglobin (HbA1c) and fasting plasma glucose (FPG) levels, body weight, and basal insulin dose were evaluated over 6 months. Dulaglutide was comparable to three injections of prandial insulin in terms of glycemic control (HbA1c 7.1% vs. 7.0%; 95% confidence interval [CI], –0.53 to 0.28; P=0.53). The basal insulin and dulaglutide combination resulted in a reduction in FPG levels by 9.7 mg/dL (95% CI, 2.09 to 41.54; P=0.03), in body weight by 4.9 kg (95% CI, 2.87 to 6.98; P<0.001), and in basal insulin dose by 9.52 IU (95% CI, 5.80 to 3.23; P<0.001). Once-weekly dulaglutide may be an effective alternative for thrice-daily prandial insulin in KT recipients with T2DM currently receiving MDI therapy.
  • Keywords: Diabetes mellitus, type 2; Dulaglutide; Insulin
Multiple daily insulin injection (MDI) therapy is commonly used in type 2 diabetes mellitus (T2DM) patients who have undergone kidney transplant (KT) for diabetic end-stage renal disease (ESRD) [1]. MDI therapy is inconvenient and can induce poor compliance; thus, a weekly injectable glucagon-like peptide-1 receptor agonist (GLP-1RA), such as dulaglutide, may be suggested as a substitute for prandial insulin by decreasing the number of injections. Previous studies have demonstrated the efficacy and safety of dulaglutide in combination with basal insulin [2,3]. GLP-1RA also facilitates weight loss and reduces the risk of hypoglycemia [4-6]. However, there is limited evidence regarding the possibility of such a transition of therapy. This study examined whether dulaglutide could replace prandial insulin in KT recipients with T2DM on MDI therapy.
Study population
Initially, 68 patients with T2DM who initiated dulaglutide treatment after KT from January 1, 2016, to December 31, 2019, at Asan Medical Center (Seoul, Korea) were reviewed. Of these patients, those who were not receiving MDI therapy (n=6), received KT for ESRD due to diseases other than diabetes (n=4), used dulaglutide for less than 6 months (n=10), had missing values (n=5), were hospitalized for other diseases (n=4), or had discontinued dulaglutide due to adverse events (n=2), were excluded. Finally, 37 patients who switched from prandial insulin to dulaglutide, and continued dulaglutide for more than 6 months, were included in the retrospective chart review. The patients were initiated on 0.75 mg of dulaglutide, which was increased to 1.5 mg only if adverse events were tolerable after 1 month. This study was conducted in compliance with the ethical guidelines of the Declaration of Helsinki and Korean Good Clinical Practice and was approved by the Institutional Review Board of the Asan Medical Center (2018-1050). Informed consent was waived by the board.
Measurements
Baseline data regarding age, sex, weight, height, blood pressure, duration of diabetes, insulin dose, presence of hypertension or dyslipidemia, and dulaglutide dose were collected by reviewing the electronic medical records. Body mass index (BMI) was calculated by dividing weight in kilograms by the square of height in meters, and blood pressure was measured by an automatic manometer after a 5-minute rest. Laboratory measurements, including serum levels of glycosylated hemoglobin (HbA1c), fasting plasma glucose (FPG), fasting C-peptide, total cholesterol, triglycerides, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, creatinine, and liver enzymes, were conducted at baseline, 3 months (±4 weeks), and 6 months (±4 weeks) after dulaglutide treatment.
Study outcomes
The primary outcome was the change in HbA1c levels over the 6-month treatment duration. The secondary outcomes were the changes in FPG levels, body weight, and basal insulin dose between baseline and 6 months. Adverse events were reviewed from the electronic medical records.
Statistical analysis
Continuous variables were expressed as mean±standard deviation, and categorical variables as percentages. The baseline characteristics were compared using Student’s t-tests and chi-square tests for continuous and categorical variables, respectively. To compare the changes in HbA1c, FPG, body weight, and basal insulin dose between baseline and 6 months, paired t-test was performed. SPSS software version 23.0 for Windows (IBM Co., Armonk, NY, USA) was used for all statistical analyses.
Baseline characteristics
The baseline characteristics of the patients are presented in Table 1. The mean age was 54.8±8.5 years, and 48.6% of patients were male. The mean total insulin dose was 44.5±17.2 IU/day; the basal dose was 24.76±12.1 IU/day, and the prandial dose was 20.5±8.4 IU/day. The mean HbA1c level was 7.0%±0.9%, and the mean BMI was 25.7±3.4 kg/m2. Seventeen (45.9%) and 20 (54.1%) patients were administered 0.75 and 1.5 mg of dulaglutide, respectively.
Efficacy of dulaglutide as a replacement of prandial insulin
Fig. 1 shows the efficacy of dulaglutide. HbA1c levels were not significantly different between baseline and 6 months (HbA1c 7.00% vs. 7.12%; P=0.53). FPG levels, body weight, and basal insulin dose all significantly decreased after 6 months. FPG levels significantly decreased from 145.43 to 123.62 mg/dL (–21.81 mg/dL; P=0.03). The mean body weight (72.11 kg) was reduced to 67.18 kg (P<0.001). The basal insulin dose was also decreased by 9.52 units from 24.76 to 15.24 units (P< 0.001). The trough level of tacrolimus and dose of corticosteroid did not change significantly over the 6-month period (Supplementary Table 1).
Adverse events
Adverse events were reported in 17 (45.9%) and 11 patients (29.7%) after 3 and 6 months of dulaglutide treatment, respectively (Supplementary Table 2). Gastrointestinal symptoms were the most frequently reported adverse event during both time points (14 [37.8%] vs. 8 [21.6%]), with nausea being the most common symptom (7 [18.9%] vs. 4 [10.8%]). Hypoglycemia was reported in only three patients during the 6-month follow-up, and severe hypoglycemia requiring hospitalization was not documented.
This study showed that dulaglutide may be used as a substitute for prandial insulin in patients with T2DM without insulin deficiency on MDI therapy after KT. The patients were started on MDI therapy for strict blood glucose control after KT due to administration of high dose immunosuppressants, not absolute insulin deficiency. After transitioning from MDI therapy to basal insulin plus dulaglutide, FPG levels, body weight, and insulin dose were significantly reduced. Decrease in insulin dose and the weight-reducing effect of dulaglutide both seem to have contributed to the reduction of body weight. HbA1c levels were maintained even after replacing prandial insulin with dulaglutide; therefore, the change in medication was shown not to affect glycemic control.
In a previous prospective study, 25 patients with T2DM receiving MDI therapy were randomized to either continue MDI therapy or to shift to basal insulin plus liraglutide for 24 weeks. The group receiving basal insulin plus liraglutide showed significant reductions in HbA1c levels, body weight, and daily insulin dose by 0.6%, 2.5 kg, and 17.4 units, respectively. On the other hand, the group on continued MDI therapy showed no difference in HbA1c levels or daily insulin dose, with a significant increase in body weight [7]. In our study, the transition from MDI therapy to basal insulin and dulaglutide resulted in significant reductions in FPG, body weight, and insulin dose without changes in HbA1c. It is important to note that while the previous study was completed in a prospective setting for restricted patients receiving a daily GLP-1RA liraglutide, the current study retrospectively analyzed the efficacy of weekly GLP-1RA dulaglutide in a real-world practice setting [7].
While the risks of hypoglycemia and weight gain are inevitable with insulin, they can be reduced with GLP-1RA. In this study, replacing prandial insulin with dulaglutide decreased weight, with only three hypoglycemic events reported. Similar results were observed in previous studies comparing the addition of either prandial insulin or GLP-1RA to basal insulin. The GetGoal Duo-2 trial showed that adding daily lixisenatide was superior to adding prandial insulin in terms of weight loss and hypoglycemia [8]. Likewise, adding weekly albiglutide to basal insulin resulted in significant weight reduction and a low hypoglycemia risk compared with adding prandial insulin [9].
Replacing prandial insulin with a GLP-1RA was associated with better patient satisfaction. In a study of 26 patients, a significantly higher satisfaction score was seen in the group that shifted from MDI therapy to lixisenatide and basal insulin compared to the group that continued MDI therapy [10]. Another study showed that the self-reported patient satisfaction score of the patients receiving liraglutide plus basal insulin significantly improved compared with the MDI group [7]. Thus, switching thrice-daily prandial insulin to once-weekly dulaglutide may be expected to improve patient satisfaction by decreasing the injection frequency.
This study consisted of patients receiving MDI therapy after KT. In a previous study on solid organ transplant recipients with diabetes, dulaglutide exhibited positive results for reducing body weight and insulin dose [11]. Furthermore, GLP-1RA decreased insulin dose and hypoglycemia risk in KT recipients [12]. Our results are consistent with these studies and support the use of dulaglutide for glycemic control in KT recipients.
The adverse events indicated in this study were similar to those reported in previous studies on GLP-1RAs [13]. Although gastrointestinal problems were reported by 14 patients at the 3-month follow-up, all 14 patients continued dulaglutide for another 3 months, and six patients showed improvement in symptoms with sustained use of dulaglutide.
This study has several limitations. First, it was a small, retrospective study, and the follow-up period was relatively short to evaluate the long-term effects of dulaglutide. Second, metformin and sulfonylurea were used along with dulaglutide in some patients, which may have influenced the efficacy of dulaglutide. Third, postprandial plasma glucose levels were not measured; thus, dulaglutide’s efficacy in lowering postprandial glucose could only be predicted by HbA1c levels. Lastly, this study only included KT recipients with relatively good glycemic control and no insulin deficiency, thus, results may not be applicable to all KT recipients. Therefore, when considering a shift in therapy, the patient’s insulin secretion ability should be evaluated. Despite these limitations, our study is the first to evaluate the transition from prandial insulin to a weekly GLP-1RA in a realworld setting. Further prospective studies targeting a larger population of patients receiving MDI therapy for various reasons will be necessary to validate the efficacy of this method.
In conclusion, combination therapy with dulaglutide and basal insulin is comparable to MDI therapy in terms of glycemic control. Replacement of prandial insulin with a weekly GLP-1RA may be effective for KT recipients with T2DM under stable glycemic control with MDI therapy.
Supplementary materials related to this article can be found online at https://doi.org/10.4093/dmj.2020.0180.
Supplementary Table 1.
Changes in administered doses and trough levels of immunosuppressant drugs after 6-month treatment with dulaglutide
dmj-2020-0180-suppl1.pdf
Supplementary Table 2.
Adverse events
dmj-2020-0180-suppl2.pdf

CONFLICTS OF INTEREST

No potential conflict of interest relevant to this article was reported.

AUTHOR CONTRIBUTIONS

Conception or design: H.S.K., W.J.L.

Acquisition, analysis, or interpretation of data: H.S.K., J.L., C.H.J., J.Y.P., W.J.L.

Drafting the work or revising: H.S.K., J.L., W.J.L.

Final approval of the manuscript: H.S.K., J.L., C.H.J., J.Y.P., W.J.L.

FUNDING

None

Acknowledgements
None.
Fig. 1.
Measures of therapeutic efficacy of dulaglutide over 6 months. (A) Glycosylated hemoglobin (HbA1c), (B) fasting plasma glucose (FPG), (C) body weight, and (D) basal insulin dose. IU, international unit.
dmj-2020-0180f1.jpg
dmj-2020-0180f2.jpg
Table 1.
Baseline characteristics of the study participants
Characteristic Total (n=37)
Male sex 18 (48.6)
Age, yr 54.8±8.5
T2DM duration, yr 17.8±8.4
Duration after KT, mo 10.6±7.5
Total daily insulin dose, IU 44.5±17.4
 Basal 24.8±12.1
 Bolus 20.5±8.4
Weight, kg 72.1±11.6
Height, cm 167.3±7.8
BMI, kg/m2 25.7±3.4
SBP, mm Hg 130.4±17.8
DBP, mm Hg 72.3±11.1
HbA1c, % 7.0±0.9
FPG, mg/dL 145.4±42.9
C-peptide, ng/mL 2.1±0.3
Total cholesterol, mg/dL 171.2±43.3
Triglycerides, mg/dL 127.3±54.2
HDL-C, mg/dL 50.7±11.5
LDL-C, mg/dL 106.7±34.2
Creatinine, mg/dL 1.1±0.3
eGFR, mL/min/1.73 m2 71.7±18.5
AST, IU/L 20.7±6.5
ALT, IU/L 17.9±8.3
Dulaglutide dose
 0.75 mg 17 (45.9)
 1.5 mg 20 (54.1)
Hypertension 18 (48.6)
Dyslipidemia 18 (48.6)
Use of oral anti-diabetic drugs
 Metformin 34 (91.9)
 Sulfonylurea 19 (51.4)
Presence of retinopathy
 NPDR 3 (8.1)
 PDR 26 (70.3)
 Not specified 8 (21.6)

Values are presented as number (%) or mean±standard deviation.

T2DM, type 2 diabetes mellitus; KT, kidney transplant; BMI, body mass index; SBP, systolic blood pressure; DBP, diastolic blood pressure; HbA1c, glycosylated hemoglobin; FPG, fasting plasma glucose; HDL-C, high-density lipoprotein cholesterol; LDL-C, low-density lipoprotein cholesterol; eGFR, estimated glomerular filtration rate; AST, aspartate aminotransferase; ALT, alanine aminotransferase; NPDR, non-proliferative diabetic retinopathy; PDR, proliferative diabetic retinopathy.

  • 1. Suthanthiran M, Strom TB. Renal transplantation. N Engl J Med 1994;331:365-76.ArticlePubMed
  • 2. Pozzilli P, Norwood P, Jodar E, Davies MJ, Ivanyi T, Jiang H, et al. Placebo-controlled, randomized trial of the addition of once-weekly glucagon-like peptide-1 receptor agonist dulaglutide to titrated daily insulin glargine in patients with type 2 diabetes (AWARD-9). Diabetes Obes Metab 2017;19:1024-31.ArticlePubMedPDF
  • 3. Lee J, Cho YK, Kim HS, Jung CH, Park JY, Lee WJ. Dulaglutide as an add-on to insulin in type 2 diabetes; clinical efficacy and parameters affecting the response in real-world practice. Diabetes Metab Syndr Obes 2019;12:2745-53.PubMedPMC
  • 4. Htike ZZ, Zaccardi F, Papamargaritis D, Webb DR, Khunti K, Davies MJ. Efficacy and safety of glucagon-like peptide-1 receptor agonists in type 2 diabetes: a systematic review and mixed-treatment comparison analysis. Diabetes Obes Metab 2017;19:524-36.ArticlePubMedPDF
  • 5. Qie S, Li X, Wang X, Liu Y, Li J, Liu G. Efficacy and safety of long-acting glucagon-like peptide-1 receptor agonist dulaglutide in patients with type 2 diabetes: a systematic review and meta-analysis of 21 randomized controlled trials. Endocrine 2020;68:508-17.ArticlePubMedPDF
  • 6. Mody R, Grabner M, Yu M, Turner R, Kwan AY, York W, et al. Real-world effectiveness, adherence and persistence among patients with type 2 diabetes mellitus initiating dulaglutide treatment. Curr Med Res Opin 2018;34:995-1003.ArticlePubMed
  • 7. Yamamoto S, Hayashi T, Ohara M, Goto S, Sato J, Nagaike H, et al. Comparison of liraglutide plus basal insulin and basalbolus insulin therapy (BBIT) for glycemic control, body weight stability, and treatment satisfaction in patients treated using BBIT for type 2 diabetes without severe insulin deficiency: a randomized prospective pilot study. Diabetes Res Clin Pract 2018;140:339-46.ArticlePubMed
  • 8. Rosenstock J, Guerci B, Hanefeld M, Gentile S, Aronson R, Tinahones FJ, et al. Prandial options to advance basal insulin glargine therapy: testing lixisenatide plus basal insulin versus insulin glulisine either as basal-plus or basal-bolus in type 2 diabetes: the GetGoal Duo-2 trial. Diabetes Care 2016;39:1318-28.ArticlePubMedPDF
  • 9. Rosenstock J, Fonseca VA, Gross JL, Ratner RE, Ahren B, Chow FC, et al. Advancing basal insulin replacement in type 2 diabetes inadequately controlled with insulin glargine plus oral agents: a comparison of adding albiglutide, a weekly GLP-1 receptor agonist, versus thrice-daily prandial insulin lispro. Diabetes Care 2014;37:2317-25.ArticlePubMedPDF
  • 10. Miya A, Nakamura A, Miyoshi H, Cho KY, Nagai S, Kurihara Y, et al. Satisfaction of switching to combination therapy with lixisenatide and basal insulin in patients with type 2 diabetes receiving multiple daily insulin injection therapy: a randomized controlled trial. J Diabetes Investig 2018;9:119-26.ArticlePubMedPDF
  • 11. Singh P, Pesavento TE, Washburn K, Walsh D, Meng S. Largest single-centre experience of dulaglutide for management of diabetes mellitus in solid organ transplant recipients. Diabetes Obes Metab 2019;21:1061-5.ArticlePubMedPDF
  • 12. Kukla A, Hill J, Merzkani M, Bentall A, Lorenz EC, Park WD, et al. The use of GLP1R agonists for the treatment of type 2 diabetes in kidney transplant recipients. Transplant Direct 2020;6:e524.ArticlePubMedPMC
  • 13. Li Z, Zhang Y, Quan X, Yang Z, Zeng X, Ji L, et al. Efficacy and acceptability of glycemic control of glucagon-like peptide-1 receptor agonists among type 2 diabetes: a systematic review and network meta-analysis. PLoS One 2016;11:e0154206.ArticlePubMedPMC

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      Nefrología (English Edition).2024; 44(6): 885.     CrossRef
    • Sweet and simple as syrup: A review and guidance for use of novel antihyperglycemic agents for post‐transplant diabetes mellitus and type 2 diabetes mellitus after kidney transplantation
      S. Elise Lawrence, Mary Moss Chandran, Jeong M. Park, Helen Sweiss, Thomas Jensen, Palak Choksi, Barrett Crowther
      Clinical Transplantation.2023;[Epub]     CrossRef
    • Novel Drugs for the Management of Diabetes Kidney Transplant Patients: A Literature Review
      Nancy Daniela Valencia-Morales, Beatriz Rodríguez-Cubillo, Rómulo Katsu Loayza-López, Maria Ángeles Moreno de la Higuera, Ana Isabel Sánchez-Fructuoso
      Life.2023; 13(6): 1265.     CrossRef
    • Tolerability and Effectiveness of Switching to Dulaglutide in Patients With Type 2 Diabetes Inadequately Controlled With Insulin Therapy
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      Frontiers in Endocrinology.2022;[Epub]     CrossRef

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      Dulaglutide as an Effective Replacement for Prandial Insulin in Kidney Transplant Recipients with Type 2 Diabetes Mellitus: A Retrospective Review
      Diabetes Metab J. 2021;45(6):948-953.   Published online February 5, 2021
      DOI: https://doi.org/10.4093/dmj.2020.0180
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    Dulaglutide as an Effective Replacement for Prandial Insulin in Kidney Transplant Recipients with Type 2 Diabetes Mellitus: A Retrospective Review
    Image Image
    Fig. 1. Measures of therapeutic efficacy of dulaglutide over 6 months. (A) Glycosylated hemoglobin (HbA1c), (B) fasting plasma glucose (FPG), (C) body weight, and (D) basal insulin dose. IU, international unit.
    Graphical abstract

    Fig. 1.

    Graphical abstract

    Dulaglutide as an Effective Replacement for Prandial Insulin in Kidney Transplant Recipients with Type 2 Diabetes Mellitus: A Retrospective Review
    Characteristic Total (n=37)
    Male sex 18 (48.6)
    Age, yr 54.8±8.5
    T2DM duration, yr 17.8±8.4
    Duration after KT, mo 10.6±7.5
    Total daily insulin dose, IU 44.5±17.4
     Basal 24.8±12.1
     Bolus 20.5±8.4
    Weight, kg 72.1±11.6
    Height, cm 167.3±7.8
    BMI, kg/m2 25.7±3.4
    SBP, mm Hg 130.4±17.8
    DBP, mm Hg 72.3±11.1
    HbA1c, % 7.0±0.9
    FPG, mg/dL 145.4±42.9
    C-peptide, ng/mL 2.1±0.3
    Total cholesterol, mg/dL 171.2±43.3
    Triglycerides, mg/dL 127.3±54.2
    HDL-C, mg/dL 50.7±11.5
    LDL-C, mg/dL 106.7±34.2
    Creatinine, mg/dL 1.1±0.3
    eGFR, mL/min/1.73 m2 71.7±18.5
    AST, IU/L 20.7±6.5
    ALT, IU/L 17.9±8.3
    Dulaglutide dose
     0.75 mg 17 (45.9)
     1.5 mg 20 (54.1)
    Hypertension 18 (48.6)
    Dyslipidemia 18 (48.6)
    Use of oral anti-diabetic drugs
     Metformin 34 (91.9)
     Sulfonylurea 19 (51.4)
    Presence of retinopathy
     NPDR 3 (8.1)
     PDR 26 (70.3)
     Not specified 8 (21.6)
    Table 1. Baseline characteristics of the study participants

    Values are presented as number (%) or mean±standard deviation.

    T2DM, type 2 diabetes mellitus; KT, kidney transplant; BMI, body mass index; SBP, systolic blood pressure; DBP, diastolic blood pressure; HbA1c, glycosylated hemoglobin; FPG, fasting plasma glucose; HDL-C, high-density lipoprotein cholesterol; LDL-C, low-density lipoprotein cholesterol; eGFR, estimated glomerular filtration rate; AST, aspartate aminotransferase; ALT, alanine aminotransferase; NPDR, non-proliferative diabetic retinopathy; PDR, proliferative diabetic retinopathy.

    Table 1.

    Kim HS, Lee J, Jung CH, Park JY, Lee WJ. Dulaglutide as an Effective Replacement for Prandial Insulin in Kidney Transplant Recipients with Type 2 Diabetes Mellitus: A Retrospective Review. Diabetes Metab J. 2021;45(6):948-953.
    Received: Jul 23, 2020; Accepted: Nov 11, 2020
    DOI: https://doi.org/10.4093/dmj.2020.0180.
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