OBJECTIVES : The objectives of this retrospective observational study were to describe patient characteristics and evaluate glycemic response (change in HbA1c) among patients with uncontrolled type 2 diabetes (T2D) initiating dulaglutide alone or in combination with insulin.

METHODS : Adults with T2D initiating dulaglutide (index date) between November 2014-February 2017 from the Practice Fusion electronic health record database were included. Patients with diagnosis of T2D, no prior GLP-1 receptor agonist prescription in 13-month baseline period, ≥1 HbA1c result of ≥7% in the 6-month baseline, and ≥1 HbA1c result in the 3-9 month follow-up period were included. DULA (dulaglutide alone and no insulin prescription during 13-month baseline to 90 days post-index) and DULA+INS (dulaglutide with insulin prescription during 13-month baseline to 90 days post-index) cohorts were evaluated.

RESULTS : Of the 952 eligible patients, 77.7% were in DULA and 22.3% were in the DULA+INS cohorts. DULA+INS patients were older (mean 61 vs 59 years, p=0.036) and were more likely to be blacks (21.2 vs 13.4%, p=0.009) than DULA patients. At baseline, DULA+INS patients had higher mean HbA1c (9.2 vs 8.8%, p<0.001) and higher mean Diabetes Complications Severity Index score (2.1 vs 1.3, p<0.001); higher proportion of patients with chronic kidney disease (15.6 vs 5.8%, p<0.001) and an endocrinologist visit (29.7 vs 20.7%, p=0.017) compared to DULA cohort (all p values <0.05). At follow-up, both cohorts showed a significant mean change in HbA1c, -0.77% (p<0.0001) and -0.96% (p<0.0001) in DULA+INS and DULA cohorts, respectively. 46.2% of DULA+INS and 55.7% of DULA patients either reached HbA1c goal of <7% or had ≥1% drop in HbA1c.

CONCLUSIONS : There were significant differences in patient characteristics between the cohorts, with DULA+INS patients presenting with a more complex clinical profile. In this real-world setting, dulaglutide treatment alone or in combination with insulin was effective in reducing HbA1c among patients with uncontrolled T2D.