2016 Volume 59 Issue 10 Pages 713-718
The case involves a 95-year-old woman who has been receiving oral treatment since the onset of diabetes and hypertension in 1995. In 2015, she developed acute heart failure but is in remission. Following the heart failure episode, her diabetes had been managed with repaglinide at a dose of 1.5 mg/day. In March 2016, the patient was referred to us due to symptoms of general fatigue and dyspnea. We confirmed a casual blood glucose level of 501 mg/dL and HbA1c level of 11.1 % and observed worsening heart failure. In the acute stage, we used diuretics and treated the hyperglycemia and heart failure with insulin. After remission of the heart failure, we temporarily discontinued the diabetes drug in favor of continuous glucose monitoring (CGM). One week later, we administered subcutaneous injections of dulaglutide (0.75 mg/week), while continuing the CGM. The mean blood glucose±standard deviation declined at each reading, from before the injection and at 1, 2, and 3 weeks after: 233±61 mg/dL, 220±54 mg/dL, 190±47 mg/dL, and 173±42 mg/dL, respectively. At this point, we determined that sufficient glycemic control had been achieved for this particular patient and transferred her to home care, having instructed the family about the administration of the injections. This case shows the effectiveness of weekly administration of a glucagon-like peptide-1 analog in very elderly diabetic patients.
