1028-P: Is Once-Weekly GLP-1 Receptor Agonist a Reasonable Option for Glucocorticoid-Induced Hyperglycemia? Twelve-Week Efficacy and Safety of Dulaglutide vs. Sitagliptin in Patients with Diabetes on Routine Glucocorticoid Treatment

Background: The efficacy and safety of incretin-based therapies for glucocorticoid-induced hyperglycemia, for which insulin is often used, remain to be established in real-world clinical settings. We aimed to study whether a once-weekly GLP-1 receptor agonist improves glycemic control in patients on glucocorticoid therapy compared with a DPP-4 inhibitor. Methods: We retrospectively compared the 12-week efficacy and safety of dulaglutide versus sitagliptin in patients with diabetes on prednisolone treatment (4-40 mg/day) who visited our hospital from 2015 to 2018. Results: Among 73 patients who started dulaglutide or sitagliptin for glucocorticoid-induced hyperglycemia while on prednisolone treatment (4-40 mg/day), 40 patients continued dulaglutide or sitagliptin along with prednisolone (4-40 mg/day) for the entire treatment period of 12 weeks (n =16, 24, respectively). The baseline characteristics and change in prednisolone doses from baseline to 1-12 weeks were comparable between the two groups. Dulaglutide significantly reduced the HbA1c and total daily insulin doses per bodyweight from baseline to 12 weeks (-0.78, p = 0.034; -0.29, p = 0.001, respectively), whereas neither was achieved by sitagliptin (-0.26, p = 0.088; -0.12, p = 0.105). A significantly higher proportion of patients were insulin-free at 12 weeks in the dulaglutide group than in the sitagliptin group (61.5% vs. 20.0%, p = 0.046). As for adverse events, nausea and vomiting were observed in 11.1% of the dulaglutide group. Hypoglycemia was not observed in either group. Conclusions: Compared with sitagliptin, dulaglutide can be an effective option for glucocorticoid-induced hyperglycemia with acceptable tolerability in real-world clinical settings.