Comparing Real-World Effectiveness of Dulaglutide and Insulin as the First Injectable for Patients with Type 2 Diabetes: An Australian Single-Site Retrospective Chart Review

AIM: To compare the real-world effectiveness of once-weekly dulaglutide 1.5 mg with insulin in injectable-naïve patients with type 2 diabetes mellitus (T2DM). METHODS: A non-interventional, non-randomised, observational, single-site retrospective chart review enrolled 150 patients, 75 receiving dulaglutide or insulin. Data were collected from electronic medical records of patients with T2DM who were initiated on insulin between October 2010 and May 2017, and patients initiated on dulaglutide between May 2018 and October 2019. A doubly robust approach was used to adjust for potential selection bias with augmented inverse probability weights used to estimate the average treatment effect. RESULTS: HbA1c favoured dulaglutide with an average change of − 1.6% vs − 0.8% for insulin, with an average treatment effect difference of 0.8% (95% confidence interval (CI) 0.4–1.2%) at 3 months. At 6 months, 58.7% of the dulaglutide group reached a target HbA1c of ≤ 7% compared with 20.0% of the insulin group: average treatment effect difference of 21.3% (95% CI 2.7–43.1). The dulaglutide group lost 2.4 kg compared to the insulin group which gained 2.0 kg: average difference of 4.4 kg (95% CI 2.6–7.3) at 6 months. The incidence of hypoglycaemic events was 12 (16.0%) occurrences in the dulaglutide group compared to 33 (44.0%) in the insulin group. CONCLUSION: Once-weekly dulaglutide demonstrated greater HbA1c reduction, weight loss and reduced hypoglycaemia compared to insulin, in a real-world practice setting.