Endocrine Abstracts

Introduction: Despite basal-bolus regime many type 2 diabetic patients do not achieve good glycemic control. Obesity and a large number of insulin units per day, even in combination with metformin and/or SGLT-2 inhibitors, are challenge in treatment of those patients.

Aim: To assess changes of glycemia, body weight and daily dose of insulin in a group of type 2 diabetic patients treated with basal-bolus scheme (with/without peroral agents), starting with an addition of weekly GLP-1 agonist dulaglutide.

Material and methods: Twenty-two patients (9 female, 13 male) with type 2 diabetes were included. Metabolic parameters (body weight, body mass index /BMI/, HbA1c, fasting glucose, postprandial glucose, daily basal insulin dose, daily bolus insulin dose) were observed in the beggining of the study and 3 months later.

Results: For women: average initial body weight was 111.8±15.5 kg, BMI 43.3±7.1 kg/m², HbA1c 8.4±1.2%, C-peptide value range 0.57–1.21 pmol/mL, fasting glucose 9.2±2.2 mmol/l, postprandial glucose 11.3±3.2 mmol/l, daily basal insulin 54.1±28.1 units (range 22–132), daily bolus insulin 62.6±37.9 units (28–150). Three months later patients lost body weight 3.2±2.4 kg (0–7 kg), HbA1c was 7.2±1.0%, fasting glucose 7.3±1.4 mmol/l, postprandial glucose 8.2±1.7 mmol/l, daily basal insulin was lower: 48.4±37.1 units (range 0–120), daily bolus insulin decreased to 45±27.2 units (range 0–80).

Male patients: average initial body weight was 133±19.3 kg, BMI 43.2±6.5 kg/m², HbA1c 8.7±1.2%, C-peptide value range 0.42–1.31 pmol/mL fasting glucose 8.2±1.7 mmol/l, postprandial glucose 10.5±2.5 mmol/l, daily basal insulin 97.9±135.4 units (range 13–540), daily bolus insulin 82.9±51.9 units (range 20–200). Three months later patients lost body weight 4.4±4.1 kg (0–13 kg), HbA1c was 7.3±0.8%, fasting glucose 8.0±1.8 mmol/l, postprandial glucose 8.7±1.9 mmol/l, daily basal insulin dose was lower: 53±33.2 units (range 0–120), daily bolus insulin also decreased to 48.8±40 units (range 0–146).

Conclusion: Addition of GLP-1 agonist on basal-bolus regime in type 2 diabetic patients resulted in weight lost in almost all patients, reduction of basal and bolus daily doses, especially in insulin resistant patients, and achieving a better glycemic control.