Adding Trulicity to SGLT2 Inhibitor Can Help Lower A1C, Clinical Study Shows

You’re working hard, watching your diet, exercising, and taking your medicine like clockwork, but still you dread receiving your A1C results. For some people with Type 2 diabetes, however, the results of that test (which show average blood sugar control over the previous 2–3 months) may soon be looking up — or more accurately, down — thanks to a recent clinical study.

Findings of the phase IIIb AWARD-10 study published Feb. 23 in The Lancet Diabetes and Endocrinology offer evidence that a new combination of therapies for Type 2 can lower glucose levels. The key is that each element of the combination combats the disease through different mechanisms.

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The study followed 424 patients in eight countries over a period of 24 weeks, garnering positive results. The data showed that when a sodium-glucose co-transporter-2 (SGLT2) inhibitor, which blocks the protein that helps the kidneys reabsorb glucose, isn’t enough, the addition of dulaglutide (brand name Trulicity) can help. Dulaglutide is a weekly injectable glucagon-like peptide-1 (GLP-1) receptor agonist that performs several tasks, all designed to keep blood sugar in check: limiting how much sugar is released into your bloodstream from your liver, slowing how quickly food leaves your stomach, and helping your pancreas release insulin in response to high blood sugar after you eat.

The combined therapy proved effective and safe for adults at two different dosages, and was studied both with and without metformin, another drug commonly used by people with Type 2 diabetes; it prevents the liver from releasing excess glucose and makes muscle and fat cells more sensitive to available insulin.

“I’ve seen in my practice that even with effective oral medicines like SGLT-2 inhibitors and metformin, many adults with Type 2 diabetes may still need additional therapy to maintain their blood sugar levels,” said Bernhard Ludvik, MD, an associate professor of medicine at Rudolfstiftung Hospital Vienna and AWARD-10 lead author. “The AWARD-10 results suggest that the combination of once-weekly Trulicity and an SGLT-2 inhibitor shows significant promise in helping more people with Type 2 diabetes reach their treatment goals.”

Of course, it’s not a magic cure, and it’s not recommended as a first line of treatment. People with Type 2 diabetes still need to maintain their diet and exercise routines. But in those who need it, the drugs were well-tolerated, with the biggest concerns being nausea, vomiting, and diarrhea.

“Managing Type 2 diabetes with diet, exercise, and oral medications may require the addition of injectable therapy for some people, given the progressive nature of the disease,” said Brad Woodward, MD, a senior medical director at Lilly Diabetes. “AWARD-10 showed that Trulicity, when used in combination with an SGLT-2 inhibitor and metformin, may be effective and well tolerated in people with type 2 diabetes.”

Want to learn more about SGLT2 inhibitors, GLP-1 receptor agonists, and metformin? Read “Diabetes Medicine: SGLT2 Inhibitors,” “Diabetes Medicine: Non-insulin Injectable Diabetes Medications,” and “Diabetes Medicine: Metformin.”

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