Efficacy of long acting once weekly dulaglutide compared with short acting twice-daily (bid) exenatide in patients with Type 2 diabetes mellitus (T2DM): a post-hoc analysis to determine the influence of baseline HbA1c in the Assessment of Weekly AdministRation of LY2189265 in Diabetes-1 (AWARD-1) trial

Aim: To investigate the response to long- and short-acting glucagon-like peptide-1 receptor agonists based on baseline HbA1c levels. The AWARD-1 trial compared once weekly dulaglutide 1.5 mg and dulaglutide 0.75 mg to placebo and exenatide 10 µg bid in patients with T2DM on metformin and pioglitazone. Methods : The changes from baseline in HbA1c and percentages of patients reaching HbA1c targets (< 7.0%, ≤6.5%) with dulaglutide 1.5 mg and dulaglutide 0.75 mg at 26 weeks were analysed by baseline HbA1c (< 8.5%, ≥8.5%) and compared with placebo and exenatide. Results are presented (LS mean [SE]) for the change from baseline in HbA1c and percentages achieving glycaemic targets, the < 8.5% group followed by the ≥8.5% group. Results: The LS mean changes from baseline in HbA1c for dulaglutide 1.5 mg (-1.16 [0.07]%; -2.37 [0.10]%) were greater compared with placebo (0.17 [0.10]%; -0.76 [0.16]%] and exenatide (-0.64 [0.07]%; -1.86 [0.11]%) (p < 0.001, all comparisons). For both baseline groups, significantly more dulaglutide 1.5 mg patients reached targets of < 7% (92%, 47%) and ≤6.5% (80%, 26%) compared with placebo (< 7%: 55%,10%; ≤6.5%: 32%, 3%) and exenatide (< 7%: 65%, 21%; ≤6.5%: 50%, 9%) (p < 0.05, all comparisons). Dulaglutide 0.75 mg also demonstrated significant changes for both baseline groups vs. placebo (p < 0.05, both outcomes; all comparisons). Statistical significance was not achieved when comparing dulaglutide 0.75 mg with exenatide in the baseline HbA1c ≥8.5% groups. Conclusion: Regardless of baseline HbA1c, once weekly dulaglutide 1.5 mg and dulaglutide 0.75 mg showed a robust reduction in HbA1c in this population of patients with T2DM. Presenter: Heike Jung