Relative Contribution of Basal and Postprandial Hyperglycemia Stratified by A1C Categories Before and After Treatment Intensification with Dulaglutide

Dulaglutide (DU) has demonstrated non-inferiority vs. liraglutide (LIR) and superiority vs. exenatide BID (EXE) in A1c reduction. No data are available on how GLP-1RAs affect the relative contribution of basal hyperglycemia (BHG) and post-prandial hyperglycemia (PPHG) to overall hyperglycemia (OHG) across A1c categories. Data from five phase 3 studies (N=673) were pooled to assess the change in relative contributions of BHG and PPHG to diurnal OHG across different A1c categories after 6 months of treatment intensification with DU 1.5 mg as monotherapy or with oral medication(s) in patients with type 2 diabetes. BHG and PPHG were calculated using the area under the curve of the 7-point SMPG profiles. As a secondary objective, overall change in BHG for DU vs. LIR and DU vs. EXE was assessed by individual studies. At baseline, relative contributions of BHG increased and PPHG decreased with increasing A1c levels (Figure). After 6 months of treatment with DU, this pattern was maintained, despite 1.3% overall mean A1c reduction. At 6 months, the relative contribution of BHG and PPHG were similar between LIR and DU, whereas DU had lower BHG but higher PPHG contribution than EXE. The trend of relative contribution of PPHG and BHG across A1c categories is similar before and after DU treatment intensification, implying its effect on both BHG and PPHG to lower A1c.