Endocrine Disorders, Contraception, and Hormone Therapy during Pregnancy
“Bert” Bertis Britt Little in Drugs and Pregnancy, 2022
Dulaglutide is another GLP-1 inhibitor used to treat T2DM. The drug is not intended for treating type 1 diabetes, and should never be used for this disorder. It has not been studied in human pregnancy. The manufacturer reported increased embryonic loss and skeletal ossification abnormalities in pregnant rats given up to 44 times the usual human dose during organogenesis. Offspring of rabbits given 13 times the usual human dose of dulaglutide during embryogenesis had lung lobe agenesis and vertebral malformations. Under the old FDA category system, dulaglutide is pregnancy risk category C.
D
Caroline Ashley, Aileen Dunleavy, John Cunningham in The Renal Drug Handbook, 2018
The pharmacokinetics of dulaglutide were found to be similar between healthy subjects and patients with mild to severe renal impairment (CRCL<30 mL/min), including end stage renal disease (requiring dialysis).
Real-world effectiveness, adherence and persistence among patients with type 2 diabetes mellitus initiating dulaglutide treatment
Published in Current Medical Research and Opinion, 2018
Reema Mody, Michael Grabner, Maria Yu, Ralph Turner, Anita Y. M. Kwan, Whitney York, Laura Fernández Landó
A study by Alatorre et al. described the characteristics of patients initiating treatment with dulaglutide. Their findings were largely similar to the population in our current study in terms of age, region of residency and comorbidities, although lower proportions of patients in the current study used insulin, GLP-1 RAs and SGLT-2 inhibitors prior to initiation. In this same retrospective study using administrative claims, patients initiating dulaglutide had a mean PDC of 0.72, with 54% of patients being adherent and 27% discontinuing dulaglutide treatment, which is comparable to our findings24. Both Alatorre et al. and our study also showed that after dulaglutide initiation the use of sulfonylureas and DPP-4 inhibitors decreased while use of SGLT-2 inhibitors increased; the latter may be due to additional weight loss advantages.
Is retatrutide (LY3437943), a GLP-1, GIP, and glucagon receptor agonist a step forward in the treatment of diabetes and obesity?
Published in Expert Opinion on Investigational Drugs, 2023
Unfortunately, the inappropriate comparison with dulaglutide in subjects with type 2 diabetes is being repeated in an ongoing clinical trial. Thus, a phase 2 study of once-weekly retatrutide compared with placebo and dulaglutide in participants with type 2 diabetes (NCT04867785) is using 4 doses of retatrutide for about 43 weeks in 281 subjects who have failed to achieve glycemic control despite diet and exercise or on a stable dose of metformin [16]. Retatrutide is also being studied in people living with obesity: phase 2 study of once-weekly retatrutide compared with placebo in participants who have obesity or are overweight with weight-related comorbidities (NCT04881760) is over 18 months [17]. In the phase 1b trial of retatrutide, 6 doses were used; 0.5, 1.5, 3, 6, 9, and 12 mg, and it would be useful to know which doses are being taken forward to the phase 2 stage. However, the 4 doses of retatrutide that are being used in the phase 2 clinical trials are not specified on the clinicaltrials.gov website, which I consider to be an omission.
Stepwise approach to continuous glucose monitoring interpretation for internists and family physicians
Published in Postgraduate Medicine, 2022
Emily D. Szmuilowicz, Grazia Aleppo
Review of the daily glucose trends (examples shown in Figure 3(a)) showed postprandial hyperglycemia following most but not all meals. Of note, fasting hyperglycemia was noted on some days (red arrows); however, this followed elevated postprandial bedtime glucose on the preceding night, and glucose decreased by ≥50 mg/dL (≥2.8 mmol/L) overnight from bedtime to fasting the next morning. This pattern indicates that interventions targeting postprandial hyperglycemia were needed (Figure 2), and these measures would be expected to improve the fasting glucose on the next day as well. Indeed, fasting glucose levels were improved on days when postprandial hyperglycemia on the night prior was less severe (green arrows), indicating that the basal insulin dose was adequate. The therapeutic modification recommended was to increase dulaglutide to 3.0 mg once week to address the postprandial hyperglycemia. In addition, the daily glucose trends were reviewed with the patient to identify which meal choices were associated with larger versus smaller postprandial glucose increases, in order to guide meal choices. Following these interventions, there was significant improvement in TIR (increased from 65% to 86%) and TAR (decrease from 35% to 14%; Figure 3(b)).
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