Effects of Dulaglutide on Glucose Control and Renal Function

Abstract

Diabetic nephropathy is one of the leading causes of end-stage renal disease (ESRD) and hemodialysis. Cardiovascular events and mortality rates increase in patients with ESRD and hemodialysis; therefore, it is important to delay ESRD and the onset of hemodialysis. The renal effects of liraglutide, a glucagon-like peptide-1 receptor agonist, have been reported. However, dulaglutide has only been shown to reduce albuminuria in other countries, and there is no report on the effect of dulaglutide on renal function in Japanese patients. We studied the effects of dulaglutide on glucose control and renal function.　Forty-five patients started dulaglutide at Sapporo Medical University Hospital between September 2016 and September 2017 and 19 patients were ultimately included in the study. The primary outcomes were glycated hemoglobin (HbA1c) levels and the estimated glomerular filtration rate (eGFR) three months after starting dulaglutide. Changes in the eGFR were also analyzed.　Of the patients included (mean age 57.4 years), 10 were men and 9 were women. Three months after the initial administration of dulaglutide, the mean HbA1c significantly decreased from 8.9 ± 0.4% (mean ± SE) to 8.0 ± 0.4% (p = 0.019), and the eGFR significantly increased from 60.2 ± 4.7 mL/min/1.73m² (mean ± SE) to 65.3 ± 4.9 mL/min/1.73m² (p = 0.011). However, the systolic blood pressure did not change significantly (from 123.6 ± 16.2 mmHg to 125.6 ± 16.6 mmHg (p = 0.919)). 　Three months before administering dulaglutide, the mean eGFR decreased by 2.1 ± 5.6 mL/min/1.73m² and three months after the initiation of dulaglutide, the mean eGFR increased by 5.1 ± 7.9 mL/min/1.73m² (p = 0.011). 　This study suggests that the administration of dulaglutide can result in lower rates of nephropathy progression and/or increases in eGFR in patients with type 2 diabetes.