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When type 2 diabetes is difficult to control, clinicians often resort to basal-bolus insulin regimens. Could the long-acting basal insulin in such a regimen be replaced by a long-acting glucagon-like peptide-1 (GLP-1) agonist, perhaps conferring lower risk for hypoglycemia?
Dulaglutide (Trulicity) is a GLP-1 agonist that was approved by the FDA in 2014 for once-weekly injection. In a manufacturer-conducted study, researchers randomized 884 adults with glycosylated hemoglobin (HbA1c) levels ≥7.0%, despite fixed insulin doses once or twice daily, to receive weekly dulaglutide (0.75 or 1.5 mg) or daily bedtime insulin glargine (Lantus). All patients received thrice-daily prandial insulin lispro (Humalog). Participants were allowed to take metfo…