Attenuated Efficacy of Dulaglutide in Elder Type 2 Diabetes Mellitus (T2DM) Cases

Acute increase of type 2 diabetes mellitus (T2DM) is a serious medical problem. Recently, an agent known as Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) was developed for T2DM which has remarkable efficacy and safety profile. In this article, we reported 2 T2DM cases with dulaglutide treatment, showing interesting clinical course. Case 1 is an 88-year-old man with hypertension, arteriosclerosis and mild cognitive impairment (MCI) without difficulties of Quality of Life (QOL)/Activities in Daily living (ADL) in daily life. He has been rather stable on liraglutide with HbA1c 7.2%. After switching from liraglutide to dulaglutide, HbA1c decreased to 6.7% in 2 months, but later increased to 11.3% in 3 months. C-peptide index (CPI) decreased from 2.5 to 0.8. Case 2 is an 83-year-old man and was treated by degludec with CPI 1.35. After switching to dulaglutide, HbA1c decreased to 7.6% in 2 months, but later increased to 10.3% in 2 months. These two cases revealed similar clinical course. Some possibilities might be speculated, including antibody production, differences of GLP-1 RAs from man-origin or lizard-origin, changes in body weight, a possible complication of renal, hepatic inflammatory influences and the subacute decreased ability of insulin secretion in the β cells. The current report would be useful for treatment of GLP-1 RAs in the future.

Copyright 2018 by Bando H. This is an open-access article distributed under Creative Commons Attribution 4.0 International License (CC BY 4.0), which allows to copy, redistribute, remix, transform, and reproduce in any medium or format, even commercially, provided the original work is properly cited.