Efficacy of Dulaglutide in a Patient With Type 2 Diabetes, High Cardiovascular Risk, and HIV: A Case Report

Abstract

BackgroundType 2 diabetes (T2D) is a common comorbidity in people living with HIV (PLWH). Anti-hyperglycemic treatment in PLWH is still a challenge, and no randomized controlled studies using new glucose-lowering agents are currently available.Case DescriptionA 55-year-old-women was admitted to our Diabetes Unit because of hyperosmolar hyperglycemic state (HHS) and sepsis. The medical history included HIV infection and insulin-treated diabetes. On clinical examination, the lady appeared dehydrated with dry buccal mucosa, tachycardia, altered mental status, genital infection, and fever. On admission, plasma glucose was 54.5 mmol/L, HbA1c 155 mmol/mol, osmolarity 389.4 mOsm/kg, bicarbonate 24.6 mmol/L with no detectable serum ketones. The patient was treated with i.v. fluid and insulin, and antibiotic therapy commenced. Upon HHS and sepsis resolution, a basal-bolus insulin therapy was implemented that was followed by significant improvement of daily glucose profiles and progressive reduction of insulin requirement until complete discontinuation. A low dose of metformin plus linagliptin was started. Since a severe atherosclerotic disease was diagnosed, a GLP-1 receptor agonist, dulaglutide, was added to metformin upon linagliptin withdrawal with maintenance of good glycemic control, treatment adherence and amelioration of quality of life and no side effects.ConclusionThis case suggests that GLP-1 receptor agonist therapy may be effective and safe for treatment of T2D with high cardiovascular risk in PLWH, supporting the need of clinical trials directly assessing the safety and the efficacy of GLP-1 receptor agonist in these individuals.

Are glucagon‐like peptide 1 receptor agonists effective in decreasing body weight and body mass index in people living with diabetes and HIV?

“…Although GLP-1RAs are known to induce lower BW loss among the diabetic versus the non-diabetic population [6], their impact on BW remains significant; for instance, liraglutide induces a weight loss up to 10% within 56 weeks in people with type 2 diabetes [7]. However, the use of dulaglutide in our study may have reduced the overall effect on BW and BMI, as its weight loss induction is less pronounced when compared with other GLP-1RAs [4].…”

“…

Weight gain is a current concern for people living with HIV (PLWH) on antiretroviral therapy (ART) [1]. Limited data are available on glucagon-like peptide 1 receptor agonists (GLP-1RAs) in PLWH [1][2][3][4]. GLP-1RAs are effective in type 2 diabetes and they have also been approved by Food and Drug Administration and the European Medicines Agency for chronic weight management.

…”

“…In PLWH, few cases of GLP-1RAs in type 2 diabetes have been reported, describing an improvement of glycaemic control and an apparent BW loss [2][3][4], and two clinical trials on semaglutide in obese PLWH are ongoing (NCT04174755, NCT04019197).…”