Dulaglutide improves glucocorticoid-induced hyperglycemia in inpatient care and reduces dose and injection frequency of insulin

Abstract

Background: Glucocorticoid (GC)-induced hyperglycemia is characterized by elevated postprandial blood glucose, which commonly requires multiple insulin injections. We investigated whether a long-acting glucagon-like peptide-1 receptor agonist, dulaglutide (Dula), safely improved GC-induced hyperglycemia in inpatients, to reduce insulin injection frequency. Methods: The data of hospitalized patients with GC-induced hyperglycemia treated with Dula (Dula group, n = 38) or without (non-Dula group, n = 38) were retrospectively evaluated. Baseline data were collected at the beginning of GC treatment. The primary outcome in this study was glycemic control, which was compared between the groups using the six-point blood glucose (before and 2 h after each meal) profiles at discharge. The daily injection frequency of injectable drugs at discharge were also compared between groups. Results: No specific trend of underlying diseases was observed between the non-Dula and Dula groups. The proportion of patients previously administered with GC pulse therapy was comparable between the two groups. No significant differences were observed between groups, in the starting maintenance GC dose, GC dose at pretreatment of Dula and discharge, and cumulative GC dose during the observation. Six-point blood glucose levels at pretreatment and discharge were comparable between the two groups. However, daily injection frequency of injectable drugs and insulin dose were significantly lower in the Dula group than that in the non-Dula group. No differences were observed in the number of hypoglycemic events, the elevation of serum pancreatic enzyme levels, or gastrointestinal adverse events. Conclusion: These findings suggest that Dula could provide glycemic control while reducing the insulin dose and injection frequency in inpatients with GC-induced hyperglycemia. The occurrence of adverse events such as gastrointestinal symptoms and hypoglycemia did not increase in the Dula-treated patients compared to those not treated, suggesting its safety.

Glucocorticoid-Induced Hyperglycemia: A Neglected Problem

“…In a study involving healthy subjects and a meal challenge test, exenatide was shown to prevent glucose intolerance and islet cell dysfunction caused by high-dose glucocorticoids [102]. Furthermore, a retrospective study of patients with GIH demonstrated that adding dulaglutide to insulin therapy resulted in glycemic control with a reduced insulin dose and frequency, while maintained safety with respect to gastrointestinal symptoms and hypoglycemia [103]. Despite these findings, there is still a need for more longterm research to conclusively determine the efficacy and safety of GLP-1RAs in the management of GIH.…”

Corticosteroid-induced hyperglycemia

“…GIH (glucocorticoid-induced hyperglycemia) is the increase in blood glycemia resulting from the short and long-term use of glucocorticoids (GCs), including methylprednisolone pulse therapy, in diabetic or non-diabetic patients. The diagnosis of GIH occurs equally with other types of diabetes, using the criteria established by the American Diabetes Association (ADA), which are: fasting blood glucose ≥ 126 mg/dL, after 2 hours another fasting blood glucose measurement or the Oral Test Glucose Intolerance (OTGI) with levels ≥ 200 mg/dL (11.1 mmol/l), glycated hemoglobin (Hb1Ac) ≥ 6.5% or random blood glucose ≥ 200 mg/dL (11.1 mmol/l) with the patient presenting signs and symptoms of hyperglycemia or hyperglycemic crisis (Aberer et al, 2021;Hwang et al, 2014;Litty et al, 2017;Nakamura et al, 2020;Uchinuma et al, 2020).…”

Treatment of Glucocorticoid- induced hyperglycemia in hospitalized patients - A Systematic Review and Meta- Analysis

“…Recent trials have challenged the insulin-only strategy in hospitalized patients and have investigated the use of Glucagon-like peptide 1-analogues (GLP-1 analogues). [39][40][41] In GC-induced hyperglycemia, data is scarce, however a trial in healthy volunteers 42 and a retrospective observational study 43 show promising results. Not only due to the effect of GLP-1 analogues on insulin resistance and glucose tolerance, but mainly due to the low risk of hypoglycemia.…”