並列タイトル等インスリン使用中の維持血液透析患者におけるGLP-1受容体作動薬デュラグルチドの併用によるその有効性および安全性に関する探索的臨床研究
一般注記Background: Dulaglutide is a once-weekly glucagon-like peptide-1 (GLP-1) receptor agonist approved for the treatment of type 2 diabetes mellitus (T2DM). However, the efficacy and safety of dulaglutide remain unclear in insulin-treated patients with T2DM on maintenance hemodialysis (HD). Methods: Dulaglutide treatment was initiated, and the insulin dose was adjusted according to the needs of individual participants. Primary outcomes were changes in the mean and standard deviation (SD) of blood glucose (BG) levels and mean amplitude of glycemic excursions (MAGE) evaluated by continuous glucose monitoring (CGM) for six days, glycated albumin (GA), glycated hemoglobin (HbA1c), pre-dialysis blood glucose levels, and daily total insulin dose from the baseline over 24 weeks. Secondary outcomes were changes in treatment satisfaction and QOL levels from the baseline, measured by using the Diabetes Treatment Satisfaction Questionnaire (DTSQ) and the Diabetes Therapy-Related Quality of Life questionnaire (DTR-QOL) scores. Results: The analysis was performed on the 12 participants who completed the study. The GA level (median-1.8 [interquartile range-6.6,-0.3] %; p=0.026) and daily total insulin dose (-15.0 [-24.5,-9.4] U/day; p=0.002) significantly decreased without increasing hypoglycemia (area over the glucose curve < 70 mg/dl: 0.0 [-0.2, 0.0] mg・24 h/dl; p=0.917). Four patients successfully withdrew from insulin therapy. The levels of HbA1c, SD of BG, and MAGE showed a decreasing tendency, but no significant improvement. Regarding treatment satisfaction and QOL, the total scores of DTSQ (8.0 [0.3, 12.5]; p=0.041) and DTR-QOL (15.5 [-1.8, 42.0]; p=0.023) significantly improved. Conclusion: Dulaglutide may help improve glycemic control, treatment satisfaction, and QOL without increasing hypoglycemia in insulin-treated patients with T2DM on maintenance HD.
Renal Replacement Therapy. 2022, 8, 26.
新大院博(医)第1087号
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受理日（W3CDTF）2023-05-05T22:12:37+09:00
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