Evaluation of therapeutic potentials of site-specific PEGylated glucagon-like peptide-1 isomers as a type 2 anti-diabetic treatment: Insulinotropic activity, glucose-stabilizing capability, and proteolytic stability

Background: For diabetic treatment, Dulaglutide has been used and effective as a glucagon-like peptide-1 receptor analogue (GLP-1 RA). This report is to describe the various responses and to analyze dulaglutide administration in the elderly with DM. Case presentation: Two patients were Type 2 Diabetes Mellitus (T2DM) treated with add-on therapy of Dulaglutide. Case 1 is 81-year-old female is diabetic for 2 years, and on Metformin and Glimepiride as Oral Hypoglycemic Agents (OHAs). Her HbA1c was higher with 10.6% and she was started to given Dulaglutide 0.75mg. Remarkable efficacy was found in 3 months with HbA1c 6.7%. Value of LDL-C increased from 135 mg/dL to 158 mg/dL. Case 2 is 83-year-old male with 27 years of diabetes. He was on medication of Metformin and Glimepiride. His HbA1c persisted around 9.0%-9.4%, then he was provided Dulaglutide as add-on therapy. In 3 months, HbA1c decreased to 8.2% and LDL-C increased from 57 mg/dL to 116 mg/dL. Discussion and conclusion: Dulaglutide is a useful GLP-1 RA with once a week administration. There were some reports concerning LDL changes after dulaglutide therapy, showing that the changes may depend on the basal LDL value before the administration of dulaglutide. Dulaglutide may influence lipid metabolism. This report is expected to become reference in diabetic practice and research in the future.

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Diabetic cases controlled with low carbohydrate diet (LCD) and GLP-1 receptor agonist (GLP-1 RA)

Asploro Journal of Biomedical and Clinical Case Reports ◽

10.36502/2019/asjbccr.6137 ◽

2019 ◽

Vol 2 (S1) ◽

pp. 38-46

Author(s):

Shirakawa M ◽

Kanamoto Y ◽

Nagaoka H ◽

Honda H ◽

Bando H

Keyword(s):

Receptor Agonist ◽

Family Care ◽

Glucose Variability ◽

Clinical Effects ◽

Low Carbohydrate Diet ◽

Low Carbohydrate ◽

Glucagon Like Peptide ◽

Glucagon Like Peptide 1 ◽

Diabetic Treatment

Recent treatment for type 2 diabetes mellitus (T2DM) has included glucagon-like peptide-1 receptor agonist (GLP-1 RA), indicating clinical efficacy for better glucose variability. Subjects were seven patients with T2DM associated with the obese tendency. Their average age was 63.8 ± 21.7 years old (5 males, 2 females) who received a new administration of GLP-1 RA (Mean ± standard deviation). For GLP-1 RA, dulaglutide (TRULICITY R, single-dose pen) was administered by subcutaneous injection 0.75 mg once a week. Basal data at 0 month revealed that body weight 76.0 ± 11.6 kg, body mass index (BMI) 29.2 ± 11.6, blood C-peptide immunoreactivity (CPR) 2.68 ± 0.49 ng/mL, respectively. After the intervention of dulaglutide, decreased value of BMI for 3 and 6-9 months was 0.78 ± 0.45 and 1.16 ± 0.85, and HbA1c for 3 and 6-9 months was 1.60 ± 1.52% and 2.01 ± 1.44%, respectively. Though these cases have various complications besides T2DM, they showed clinical effects of weight reduction and lowering blood glucose. Diabetic treatment for current cases would suggest that GLP-1 RA would be effective in various situations such as a super-aged patient, medical practice in the remote area, family care and visiting nursing.

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