Type 2 diabetes mellitus is one of the diseases the prevalence of which continues to rise all around the world. It is confirmed to be a burden for patients because of increasing treatment costs and reducing life expectancies. The approaches to the treatment of type 2 diabetes are expanding nowadays. It is generally agreed that such drugs as insulin and sulfonylureas are not very good for treatment of diabetes because of their side effects such as gaining weight and hypoglycemia. It is advised to use individual treatment plans as a first-line therapy which includes changes in lifestyle and choosing appropriate medications according to patient’s characteristics and drug properties (Scheen, 2016). Oral antihyperglycemic medications have been gaining the increased popularity as of lately because of their reducing costs and ability to control weight. New medications are easy to administrate, and they have convenient dosing frequency. The injections are also improved to be in a pen format for increasing convenience. The purpose of this paper is to summarize the research findings in treatment for adult patients suffering from type 2 diabetes.
The patients suffering from the disease in question may choose among different kinds of drugs available as medications for diabetes treatment. Currently, there are 14 classes of drugs available for the management of type 2 diabetes. Some of the newest approved therapies include glucagon-like peptide-1 receptor agonists (Miller, Nguyen, Hu, Lin, & Nguyen, 2014). It is an incretin with strong antihyperglycemic effect. Incretins can be defined as hormones secreted by cells of the small intestine while taking food orally. The mentioned type of medications causes the release of insulin from the pancreas, shuts down the secretion of glucagon and affects hypothalamus to influence satiety. This class of medications does not demonstrate significant hypoglycemia as compared to other antidiabetic drugs. It is stated that they can be used as an option and in place of metformin that is promoted as the first-line therapy by the American Association of Clinical Endocrinology.
At present, there are four agents of this type that are approved by the United States Food and Drug Administration. One of these agents is dulaglutide which is a subcutaneous injection that can be used once in a week to increase glycemic control together with an appropriate diet and physical activity. One of the characteristic features of the drugs is their composition as dulaglutide molecules “contain a human GLP-1 analog sequence covalently linked to a modified human immunoglobulin G4 (IgG4) heavy chain fragment (Fc) by a small peptide linker” (Scheen, 2016, p. 5). These elements make the medication effective in quite a wide population.
This medication was studied in six clinical trials both as a separate therapy and in combination with other therapies in type 2 diabetes treatment. According to Miller et al. (2014), during a randomized trial, the use of dulaglutide in adult patients was associated with a larger reduction of HbA1c as compared to the patients who had another treatment plan. It has been found that dulaglutide can be used as first and second-line therapy to promote weight loss and lower glycated hemoglobin. It is also pointed out that it provides cardiovascular benefits lowering blood pressure and improving the level of lipids. Still, dulaglutide has transient and mild side effects, such as nausea, diarrhea, and vomiting that are usually decreased over time. Therefore, treatment involving the use of this medication has been regarded as appropriate for adult patients with diabetes (type 2).
Some researchers reveal another property of the new medication. Many trials show that dulaglutide is effective in reducing fasting and postprandial glucose as compared to placebo among the uncontrolled patients who could not achieve positive effects while taking oral antidiabetic medications. However, Edwards and Minze (2015) state that the majority of studies show that dulaglutide serves as placebo, and it can be used as a part of treatment. They also note that similar results have been shown for daily and fasting plasma glucose comparing to placebo.
The clinical efficiency of dulaglutide is achieved by the reduction of concentrations of fasting and postprandial glucose plasma and levels of HbA1c together with body weight loss. These properties have been carefully investigated in patients and showed positive results. It is noteworthy that dulaglutide is widely used in the Asian region, and various trials have been implemented by Asian researchers. According to Scheen (2016), the use of the medication “showed indeed a greater HbA1c reduction in Asian-dominant studies than in non-Asian-dominant studies” (p.10). Future trials may also include studies focusing on dulaglutide and placebo in patients who already receive sulfonylurea therapy or insulin.
The review of evidence-based practices showed that, when comparing to other GLP-1 receptor agonists, dulaglutide demonstrates rapid and sustained weight loss and is convenient to use on a weekly basis. One of its potential benefits is the increase in ß-cell mass, which can lead to the slowdown in the progression of type 2 diabetes mellitus. Cardiovascular safety endpoints including change of systolic and diastolic blood pressure have shown positive effects for dulaglutide. Although GLP-1 receptor agonists are expensive to use, they are proved to be a new and effective option for treating type 2 diabetes in adult populations. It is a general opinion that it should be placed together with other GLP-1 receptor agonists of long action in the recommended guidelines.
Approaches to treating type 2 diabetes
- Individual treatment plans as the first-line therapy
- Numerous agents for the second-line therapy
- Increased popularity of oral antihyperglycemic medications
- Using pen-format injections for increasing convenience
- New medications for effective weight control
- New medications for low risks of hypoglycemia
Newest approved therapy to treating diabetes
- 14 classes of drugs are available
- The use of glucagon-like peptide-1 receptor agonists
- The use of drugs without significant hypoglycemia
- Medications used in place of metformin
- Medications to lower postprandial plasma glucose
- Medications to lower fasting plasma glucose
Dulaglutide as a glucagon-like peptide-1 receptor agonist
- Subcutaneous injection used once a week
- Effects of glucagon-like peptide-1 receptor agonists
- Dulaglutide molecule, its parts, and properties
- Six trials: separate and combined therapy
- The use as first and second-line therapy
Positive features of the drug under analysis
- Provides cardiovascular benefits lowering blood pressure
- Significantly improves the level of lipids
- Effective in reducing fasting and postprandial glucose
- Demonstrated promising A1c reductions in trials
- Can be used weekly in the pen-format
Negative features of dulaglutide
- Associated with transient and mild side effects
- Nausea, diarrhea, vomiting (usually decreased over time)
- It is still expensive to use
- Should be studied in the Asian population
- More studies comparing to placebo are needed
Clinical efficiency of the medication in question
- Reduction of concentrations of fasting glucose plasma
- Reduction of concentrations of postprandial glucose plasma
- Reduction of HbA1c levels and body weight
- Benefits of the increase in ß-cell mass
- New option for treating type 2 diabetes
References
Edwards, K. L., & Minze, M. G. (2015). Dulaglutide: An evidence-based review of its potential in the treatment of type 2 diabetes. Core Evidence, 10(1), 11-21.
Miller, B. R., Nguyen, H., Hu, C. J. H., Lin, C., & Nguyen, Q. T. (2014). New and emerging drugs and targets for type 2 diabetes: Reviewing the evidence. American Health & Drug Benefits, 7(8), 452-463.
Scheen, A. J. (2016). Dulaglutide (LY-2189265) for the treatment of type 2 diabetes. Expert Review of Clinical Pharmacology, 9(3), 385-399.