Objective : Prediabetes is a state of insulin resistance that can progress to diabetes at a rate of 5% to 10% per year. Published evidence suggests glucagon-like peptide-1 receptor agonists to be promising in preventing the progression of prediabetes to diabetes and promote regression to normoglycemia. The current study retrospectively evaluates the real-world clinical effectiveness of dulaglutide monotherapy in obese adults with prediabetes. To the best of our knowledge this is the first report of its kind from India.
Methods : This retrospective, single-centre study included 11 obese adults (body mass index [BMI], ≥30 kg/m2) with prediabetes (male, 8; mean age, standard deviation [SD], 38.18 [6.60] years; mean HbA1c [SD], 6.34 [0.08] %; mean body weight [SD], 101.09 [8.04] kg; mean BMI [SD], 36.16 [2.92] kg/m2). The data was retrieved from the electronic database of a hospital in Kolkata, India. Patients received once-weekly dulaglutide as monotherapy for a period of 6 months. Changes in the fasting blood glucose (FBG), postprandial blood glucose (PPBG), HbA1c, body weight, and the corresponding BMI were recorded. The outcomes were statistically analyzed using paired t-test. Adverse events during the course of treatment were also recorded.
The follow-up at 6 months demonstrated significant reduction (P<.001) from baseline in FBG, PPBG, and HbA1c with mean reduction (MR) of 28 (95% confidence interval [CI]: 19.94-36.06) mg/dL, 39.64 (95% CI: 27.45-51.83) mg/dL, and 0.69 (95% CI: 0.57-0.81) %, respectively. A significant reduction (P<.001) in body weight and BMI was also demonstrated with MR of 14.91 (95% CI: 11.32-18.50) kg and 5.25 (4.09-6.40) kg/m2, respectively. Mild nausea was reported in 1 patient, which was managed with domperidone and ondansetron. Three patients reported decrease in appetite.
Discussion : Dulaglutide monotherapy for a period of 6 months resulted in significant improvement in glycemic parameters and body weight in obese adults with prediabetes. An HbA1c target of <5.7% was achieved in 54.55% of patients. The therapy was well tolerated with no serious adverse events and none of the patients discontinued therapy. The limitations of the study include small sample size and lack of comparator arm.
Conclusion : In a real-world setting, dulaglutide monotherapy was well tolerated and demonstrated significant improvement in glycemic outcomes and body weight in obese Indian adults with prediabetes. Dulaglutide monotherapy demonstrated potential to reduce the risk of diabetes in obese adults with prediabetes. However, further investigation in a larger and appropriately powered clinical trial is warranted.
Consultant, Endocrinology and Diabetes
AMRI hospital, West Bengal, India
Dr. Supratik Bhattacharyya, MBBS, MD, MRCP (UK), FACP (USA), FRCP Edin., MS (Endocrinology & Diabetes, London), MRCPE, is an endocrinologist based in Kolkata,India with more than 11 years of experience.