Excellent Blood Glucose Levels for 5 Years with Well Maintained Insulin Secretion by the Treatment Comprising a Once-Weekly Injection of Dulaglutide: GLP- 1RA Alone in a Patient with Type 2 Diabetes Mellitus

Case Report

Austin J Endocrinol Diabetes. 2023; 10(1): 1099.

Excellent Blood Glucose Levels for 5 Years with Well Maintained Insulin Secretion by the Treatment Comprising a Once-Weekly Injection of Dulaglutide: GLP- 1RA Alone in a Patient with Type 2 Diabetes Mellitus

Seiho Nagafuchi, MD, PhD1,2*#; Keiichiro Mine, PhD2#; Taizo Shiratsuchi, BA1; Erika Shibayama, RN1; Azusa Mitsueda, RN1; Hirokazu Takahashi, MD, PhD3; Keizo Anzai, MD, PhD2

1Department of Internal Medicine, Fukuoka Heartnet Hospital, Fukuoka, 819-0002, Japan

2Division of Metabolism and Endocrinology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga, 849-8501, Japan

3Liver Center, Faculty of Medicine, Saga University Hospital, Saga University, Saga 849-8501, Japan

*Corresponding author: Seiho Nagafuchi Department of Internal Medicine, Fukuoka Heartnet Hospital, Fukuoka, 819-0002, Japan. Email: su2733@cc.saga-u.ac.jp

#These authors contributed equally to the manuscript.

Received: June 15, 2023 Accepted: July 03, 2023 Published: July 10, 2023

Abstract

As a result of worsening of diabetes mellitus control to 9.1% hemoglobin A1c, a 61-year-old male Japanese patient began treatment with once-weekly subcutaneous injection of 0.75mg dulaglutide (a glucagon-like peptide-1 receptor agonist) alone. As a result, he demonstrated excellent diabetes mellitus control at an approximate 6.0% to 6.7% hemoglobin A1c level with this treatment alone for 5 years. The insulin secretion activity was well maintained as assessed by the HOMA-β score from 2.7 to 10.2. Interestingly, slight increase of insulin resistance, as assessed by the HOMA-IR was observed from 0.7 to 1.1. Taken together, the mild increase of insulin secretion may have been a positive reaction to keep good control of diabetes mellitus in response to slightly increased insulin resistance. Thus, a long-lasting favorable effect of treatment with dulaglutide alone, not only for diabetes mellitus control, but also for keeping insulin secretion, was demonstrated by this patient.

Keywords: β-cell; Dulaglutide; Glucagon-like peptide-1 receptor agonist (GLP-1RA); Insulin resistance; Type 2 diabetes mellitus

Introduction

A recent IDF report indicated that the number of patients with diabetes mellitus globally is now approximately 800 million, which will increase by 8 million annually [1]. Almost all patients are expected to have type 2 diabetes mellitus, and an appropriate prevention program and effective and safe treatment regimens are essential. Fortunately, dipeptidyl peptidase-4 inhibitors and glucagon-like peptide-1 receptor agonist (GLP- 1RA) stimulate insulin secretion in response to diet-induced hyperglycemia, without the risk of hypoglycemia, which is in contrast to sulfonylureas (SUs) and/or insulin [2-4].

GLP-1 RA has been also reported to be useful not only to control diabetes, but also to reduce the risks of cardiovascular diseases, obesity and renal disorders [4]. The mechanisms of GLP-1RA-stimulated insulin release in pancreatic β-cells are displayed in Figure 1. Briefly, GLP-1RA stimulates pancreatic β-cells to increase the production and release of insulin through increasing Cyclic Adenosine Monophosphate (cAMP) production and calcium (Ca2+) elevation, followed by protein kinase A activation, leading to upregulation of proinsulin gene transcription and subsequent insulin secretion [3].

Citation: Nagafuchi S, Mine K, Shiratsuchi T, Shibayama E, Mitsueda A, et al. Excellent Blood Glucose Levels for 5 Years with Well Maintained Insulin Secretion by the Treatment Comprising a Once-Weekly Injection of Dulaglutide: GPL- 1RA Alone in a Patient with Type 2 Diabetes Mellitus. Austin J Endocrinol Diabetes. 2023; 10(1): 1099.