• Klíčová slova
• dulaglutid,
• MeSH
• diabetes mellitus 2. typu * farmakoterapie   MeSH
• glukagonu podobné peptidy analogy a deriváty   farmakologie   terapeutické užití   MeSH
• hmotnostní úbytek MeSH
• hypoglykemika farmakologie   terapeutické užití   MeSH
• lidé středního věku MeSH
• lidé MeSH
• obezita * farmakoterapie   MeSH
• výsledek terapie MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• kazuistiky MeSH

Agonisté receptoru pro GLP-1 (GLP-1 RA) v injekční formě patří podle doporučení ADA/EASD mezi první injekční terapii před bazálním inzulinem u pacientů s diabetes mellitus 2. typu, kteří nedosahují cílových hodnot kompenzace při terapii diabetickou dietou a perorálními antidiabetiky. Dulaglutid je dlouhodobě působící GLP-1 RA s aplikací 1x týdně, který úspěšně snižuje hodnotu glykovaného hemoglobinu HbA1c a hmotnost. Oproti inzulinu je terapie dulaglutidem spojena s nižším rizikem hypoglykemií, hmotnostních přírůstků a nevyžaduje složitou edukaci. Dávku není třeba titrovat a léčba je od počátku dobře snášena. Ve studii REWIND redukoval dulaglutid výskyt závažných KV příhod (MACE). Kazuistiky dokumentují dlouhodobou účinnost terapie dulaglutidem u diabetiků 2. typu v klinické praxi.

GLP-1 receptor agonists (GLP-1 RA) in injection form according to ADA/EASD recommendation rank among the first injection therapies preceding basal insulin in patients afflicted with type 2 diabetes who do not achieve target values of compensation during dietary therapy and peroral antidiabetics therapy. When applied once a week, dulaglutide is a long-term acting GLP-1 RA successfully reducing the glycated haemoglobin value HbA1c and weight. Compared to insulin, dulaglutide therapy is linked to a decreased risk of hypoglycaemia, lower weight accruals and does not impose demanding education. Dosage does not require titration while the therapy is right from the start well tolerated. Dulaglutide according to the REWIND study reduced the occurrence of serious CV events (MACE). In clinical practice case studies document the longterm efficacy of dulaglutide therapy for type 2 diabetes patients.

• Klíčová slova
• dulaglutid,
• MeSH
• diabetes mellitus 2. typu farmakoterapie   komplikace   MeSH
• Downův syndrom komplikace   MeSH
• glukagonu podobné peptidy analogy a deriváty   MeSH
• glykovaný hemoglobin analýza   účinky léků   MeSH
• hypoglykemika * aplikace a dávkování   škodlivé účinky   MeSH
• index tělesné hmotnosti MeSH
• komorbidita MeSH
• lidé středního věku MeSH
• lidé MeSH
• mentální retardace komplikace   MeSH
• senioři MeSH
• výsledek terapie MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• kazuistiky MeSH

Kazuistika pojednává o muži s onemocněním diabetes mellitus 2. typu s neuspokojivou kompenzací, ve stadiu chronických komplikací a ve vysokém kardiovaskulárním riziku. Pacient několik posledních let odmítal léčbu GLP-1 analogy, zejména kvůli nutnosti injekční aplikace. Při jedné z ambulantních kontrol byla použita ukázka demonstračního pera Trulicity, po které pacient uznal jednoduchost aplikace a souhlasil se zahájením léčby dulaglutidem. Po třech měsících léčby dosáhl pacient vynikající kompenzace diabetu, subjektivně je s léčbou nadmíru spokojen.

This case report describes a man with type 2 diabetes mellitus with poor diabetes control in the stage of chronic complications and at high cardiovascular risk. The patient had been refusing treatment with GLP-1 analogues for the past few years, mainly because of the need for injection application. During one of the outpatient follow-ups, the Trulicity demonstration pen was used, after which the patient acknowledged the simplicity of administration and agreed to begin treatment with dulaglutide. After three months of treatment, the patient has achieved excellent diabetes control and is subjectively satisfied with the treatment.

• Klíčová slova
• Dulaglutid,
• MeSH
• adherence a compliance při léčbě * MeSH
• adherence k farmakoterapii MeSH
• diabetes mellitus 2. typu farmakoterapie   komplikace   MeSH
• glukagonu podobné peptidy analogy a deriváty   aplikace a dávkování   terapeutické užití   MeSH
• hypoglykemika terapeutické užití   MeSH
• imunoglobuliny - Fc fragmenty MeSH
• komplikace diabetu MeSH
• krevní glukóza analýza   MeSH
• lidé MeSH
• rekombinantní fúzní proteiny MeSH
• rizikové faktory kardiovaskulárních chorob MeSH
• senioři MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• Publikační typ
• kazuistiky MeSH

AIM: To assess the occurrence of atrial fibrillation or atrial flutter (atrial arrhythmias [AA]) in patients with type 2 diabetes treated with once-weekly subcutaneous dulaglutide versus placebo. MATERIALS AND METHODS: Patients without electrocardiographic (ECG)-confirmed AA at baseline and randomized in the REWIND trial were assessed for the development of AA based on an annual ECG. Additional analyses included whether dulaglutide compared with placebo reduced the composite outcome of AA or death, AA or cardiovascular death, AA or stroke and AA or heart failure. RESULTS: Among 9543 participants (mean age 66 ± 7 years, with cardiovascular risk factors and 31% with previous cardiovascular disease) without AA at entry in the trial, 524 patients (5.5%) had at least one episode of AA during the median 5.4 years of follow-up. Incident AA occurred in 269 of the 4769 participants allocated to dulaglutide (5.6%), at a rate of 10.7 per 1000 person-years, versus 255 of the 4774 allocated to placebo (5.3%), at a rate of 10.5 per 1000 person-years (P = .59). There was also no effect of dulaglutide on the composite outcome of AA and death or AA and heart failure. CONCLUSION: This post hoc analysis of data from the REWIND trial showed that treatment with dulaglutide was not associated with a reduced incidence of AA in this at-risk group of patients with type 2 diabetes.

• MeSH
• diabetes mellitus 2. typu * komplikace   farmakoterapie   epidemiologie   MeSH
• fibrilace síní * komplikace   farmakoterapie   epidemiologie   MeSH
• glukagonu podobné peptidy analogy a deriváty   MeSH
• hypoglykemika MeSH
• imunoglobuliny - Fc fragmenty škodlivé účinky   MeSH
• lidé středního věku MeSH
• lidé MeSH
• rekombinantní fúzní proteiny škodlivé účinky   MeSH
• senioři MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• senioři MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• randomizované kontrolované studie MeSH

• MeSH
• diabetes mellitus 2. typu * MeSH
• glukagonu podobné peptidy analogy a deriváty   MeSH
• hypoglykemika terapeutické užití   MeSH
• kombinovaná farmakoterapie MeSH
• lidé MeSH
• Check Tag
• lidé MeSH

OBJECTIVE: Recent European Guidelines for Diabetes, Prediabetes and Cardiovascular Diseases introduced a shift in managing patients with type 2 diabetes at high risk for or established cardiovascular (CV) disease by recommending GLP-1 receptor agonists and SGLT-2 inhibitors as initial glucose-lowering therapy. This is questioned since outcome trials of these drug classes had metformin as background therapy. In this post hoc analysis, the effect of dulaglutide on CV events was investigated according to the baseline metformin therapy by means of a subgroup analysis of the Researching Cardiovascular Events with a Weekly Incretin in Diabetes (REWIND) trial. RESEARCH DESIGN AND METHODS: Patients in REWIND (n = 9901; women: 46.3%; mean age: 66.2 years) had type 2 diabetes and either a previous CV event (31%) or high CV risk (69%). They were randomized (1:1) to sc. dulaglutide (1.5 mg/weekly) or placebo in addition to standard of care. The primary outcome was the first of a composite of nonfatal myocardial infarction, nonfatal stroke, and death from cardiovascular or unknown causes. Key secondary outcomes included a microvascular composite endpoint, all-cause death, and heart failure. The effect of dulaglutide in patients with and without baseline metformin was evaluated by a Cox regression hazard model with baseline metformin, dulaglutide assignment, and their interaction as independent variables. Adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated by a Cox regression model with adjustments for factors differing at baseline between people with vs. without metformin, identified using the backward selection. RESULTS: Compared to patients with metformin at baseline (n = 8037; 81%), those without metformin (n = 1864; 19%) were older and slightly less obese and had higher proportions of women, prior CV events, heart failure, and renal disease. The primary outcome occurred in 976 (12%) participants with baseline metformin and in 281 (15%) without. There was no significant difference in the effect of dulaglutide on the primary outcome in patients with vs. without metformin at baseline [HR 0.92 (CI 0.81-1.05) vs. 0.78 (CI 0.61-0.99); interaction P = 0.18]. Findings for key secondary outcomes were similar in patients with and without baseline metformin. CONCLUSION: This analysis suggests that the cardioprotective effect of dulaglutide is unaffected by the baseline use of metformin therapy.

• MeSH
• diabetes mellitus 2. typu * komplikace   farmakoterapie   epidemiologie   MeSH
• glukagonu podobné peptidy analogy a deriváty   MeSH
• hypoglykemika terapeutické užití   MeSH
• imunoglobuliny - Fc fragmenty MeSH
• kardiovaskulární nemoci * epidemiologie   prevence a kontrola   MeSH
• lidé středního věku MeSH
• lidé MeSH
• metformin * terapeutické užití   MeSH
• nemoci cév * MeSH
• receptor pro glukagonu podobný peptid 1 MeSH
• rekombinantní fúzní proteiny MeSH
• senioři MeSH
• výsledek terapie MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• randomizované kontrolované studie MeSH

BACKGROUND: Cardiovascular outcome trials have suggested that glucagon-like peptide 1 (GLP-1) receptor agonists might reduce strokes. We analysed the effect of dulaglutide on stroke within the researching cardiovascular events with a weekly incretin in diabetes (REWIND) trial. METHODS: REWIND was a multicentre, randomised, double-blind, placebo-controlled trial done at 371 sites in 24 countries. Men and women (aged ≥50 years) with established or newly detected type 2 diabetes whose HbA1c was 9·5% or less (with no lower limit) on stable doses of up to two oral glucose-lowering drugs with or without basal insulin therapy were eligible if their body-mass index was at least 23 kg/m2. Participants were randomly assigned (1:1) to weekly subcutaneous injections of either masked dulaglutide 1·5 mg or the same volume of masked placebo (containing the same excipients but without dulaglutide). Randomisation was done by a computer-generated random code with an interactive web response system with stratification by site. Participants, investigators, the trial leadership, and all other personnel were masked to treatment allocation until the trial was completed and the database was locked. During the treatment period, participants in both groups were instructed to inject study drug on the same day at around the same time, each week. Strokes were categorised as fatal or non-fatal, and as either ischaemic, haemorrhagic, or undetermined. Stroke severity was assessed using the modified Rankin scale. Participants were seen at 2 weeks, 3 months, 6 months, and then every 3 months for drug dispensing and every 6 months for detailed assessments, until 1200 confirmed primary outcomes accrued. The primary endpoint was the first occurrence of any component of the composite outcome, which comprised non-fatal myocardial infarction, non-fatal stroke, or death from cardiovascular or unknown causes. All analyses were done according to an intention-to-treat strategy that included all randomly assigned participants, irrespective of adherence. The trial is registered with ClinicalTrials.gov, number NCT01394952. FINDINGS: Between Aug 18, 2011, and Aug 14, 2013, we screened 12 133 patients, of whom 9901 with type 2 diabetes and additional cardiovascular risk factors were randomly assigned to either dulaglutide (n=4949) or an equal volume of placebo (n=4952). During a median follow-up of 5·4 years, cerebrovascular and other cardiovascular outcomes were ascertained and adjudicated. 158 (3·2%) of 4949 participants assigned to dulaglutide and 205 (4·1%) of 4952 participants assigned to placebo had a stroke during follow-up (hazard ratio [HR] 0·76, 95% CI 0·62-0·94; p=0·010). Dulaglutide reduced ischaemic stroke (0·75, 0·59-0·94, p=0·012) but had no effect on haemorrhagic stroke (1·05, 0·55-1·99; p=0·89). Dulaglutide also reduced the composite of non-fatal stroke or all-cause death (0·88, 0·79-0·98; p=0·017) and disabling stroke (0·74, 0·56-0·99; p=0·042). The degree of disability after stroke did not differ by treatment group. INTERPRETATION: Long-term dulaglutide use might reduce clinically relevant ischaemic stroke in people with type 2 diabetes but does not affect stroke severity. FUNDING: Eli Lilly and Company.

• MeSH
• cévní mozková příhoda prevence a kontrola   MeSH
• diabetes mellitus 2. typu krev   farmakoterapie   patofyziologie   MeSH
• diabetické angiopatie krev   farmakoterapie   patofyziologie   MeSH
• dvojitá slepá metoda MeSH
• glukagonu podobné peptidy analogy a deriváty   terapeutické užití   MeSH
• glykovaný hemoglobin účinky léků   MeSH
• hypoglykemika terapeutické užití   MeSH
• imunoglobuliny - Fc fragmenty terapeutické užití   MeSH
• inkretiny terapeutické užití   MeSH
• lidé středního věku MeSH
• lidé MeSH
• prospektivní studie MeSH
• receptor pro glukagonu podobný peptid 1 agonisté   MeSH
• rekombinantní fúzní proteiny terapeutické užití   MeSH
• výsledek terapie MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH
• randomizované kontrolované studie MeSH

Kazuistika popisuje dlouhodobý pozitivní efekt léčby dulaglutidem u pacienta s diabetes mellitus 2. typu. Tato léčba pomohla nejen zvládnout dosud obtížně kompenzovatelné hodnoty glykemií, ale také snížit tělesnou hmotnost, zlepšit compliance k dietě a tím také zlepšit hodnoty lipidogramu.

This case report describes the positive long-lasting effect of dulaglutide in a patient with type 2 diabetes. This therapy helped not only to cope with the difficult compensation of glycaemia, but also with body weight reduction and compliance to diet, which led to lipid profile improvement.

• Klíčová slova
• dulaglutid,
• MeSH
• diabetes mellitus 2. typu farmakoterapie   MeSH
• glukagonu podobné peptidy analogy a deriváty   MeSH
• hmotnostní úbytek MeSH
• hodnocení léčiv MeSH
• hyperglykemie farmakoterapie   MeSH
• hypertriglyceridemie MeSH
• hypoglykemika aplikace a dávkování   škodlivé účinky   terapeutické užití   MeSH
• imunoglobuliny - Fc fragmenty MeSH
• individualizovaná medicína MeSH
• lidé středního věku MeSH
• lidé MeSH
• obezita MeSH
• pankreatitida * MeSH
• receptor pro glukagonu podobný peptid 1 MeSH
• rekombinantní fúzní proteiny MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• kazuistiky MeSH

BACKGROUND: Two glucagon-like peptide-1 (GLP-1) receptor agonists reduced renal outcomes in people with type 2 diabetes at risk for cardiovascular disease. We assessed the long-term effect of the GLP-1 receptor agonist dulaglutide on renal outcomes in an exploratory analysis of the REWIND trial of the effect of dulaglutide on cardiovascular disease. METHODS: REWIND was a multicentre, randomised, double-blind, placebo-controlled trial at 371 sites in 24 countries. Men and women aged at least 50 years with type 2 diabetes who had either a previous cardiovascular event or cardiovascular risk factors were randomly assigned (1:1) to either weekly subcutaneous injection of dulaglutide (1·5 mg) or placebo and followed up at least every 6 months for outcomes. Urinary albumin-to-creatinine ratios (UACRs) and estimated glomerular filtration rates (eGFRs) were estimated from urine and serum values measured in local laboratories every 12 months. The primary outcome (first occurrence of the composite endpoint of non-fatal myocardial infarction, non-fatal stroke, or death from cardiovascular causes), secondary outcomes (including a composite microvascular outcome), and safety outcomes of this trial have been reported elsewhere. In this exploratory analysis, we investigate the renal component of the composite microvascular outcome, defined as the first occurrence of new macroalbuminuria (UACR >33·9 mg/mmol), a sustained decline in eGFR of 30% or more from baseline, or chronic renal replacement therapy. Analyses were by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT01394952. FINDINGS: Between Aug 18, 2011, and Aug 14, 2013, 9901 participants were enrolled and randomly assigned to receive dulaglutide (n=4949) or placebo (n=4952). At baseline, 791 (7·9%) had macroalbuminuria and mean eGFR was 76·9 mL/min per 1·73 m2 (SD 22·7). During a median follow-up of 5·4 years (IQR 5·1-5·9) comprising 51 820 person-years, the renal outcome developed in 848 (17·1%) participants at an incidence rate of 3·5 per 100 person-years in the dulaglutide group and in 970 (19·6%) participants at an incidence rate of 4·1 per 100 person-years in the placebo group (hazard ratio [HR] 0·85, 95% CI 0·77-0·93; p=0·0004). The clearest effect was for new macroalbuminuria (HR 0·77, 95% CI 0·68-0·87; p<0·0001), with HRs of 0·89 (0·78-1·01; p=0·066) for sustained decline in eGFR of 30% or more and 0·75 (0·39-1·44; p=0·39) for chronic renal replacement therapy. INTERPRETATION: Long-term use of dulaglutide was associated with reduced composite renal outcomes in people with type 2 diabetes. FUNDING: Eli Lilly and Company.

• MeSH
• albuminurie prevence a kontrola   MeSH
• diabetes mellitus 2. typu farmakoterapie   MeSH
• diabetické nefropatie prevence a kontrola   MeSH
• dvojitá slepá metoda MeSH
• glukagonu podobné peptidy analogy a deriváty   terapeutické užití   MeSH
• hodnoty glomerulární filtrace účinky léků   MeSH
• hypoglykemika terapeutické užití   MeSH
• imunoglobuliny - Fc fragmenty terapeutické užití   MeSH
• kreatinin moč   MeSH
• lidé středního věku MeSH
• lidé MeSH
• rekombinantní fúzní proteiny terapeutické užití   MeSH
• senioři MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH
• randomizované kontrolované studie MeSH

BACKGROUND: Three different glucagon-like peptide-1 (GLP-1) receptor agonists reduce cardiovascular outcomes in people with type 2 diabetes at high cardiovascular risk with high glycated haemoglobin A1c (HbA1c) concentrations. We assessed the effect of the GLP-1 receptor agonist dulaglutide on major adverse cardiovascular events when added to the existing antihyperglycaemic regimens of individuals with type 2 diabetes with and without previous cardiovascular disease and a wide range of glycaemic control. METHODS: This multicentre, randomised, double-blind, placebo-controlled trial was done at 371 sites in 24 countries. Men and women aged at least 50 years with type 2 diabetes who had either a previous cardiovascular event or cardiovascular risk factors were randomly assigned (1:1) to either weekly subcutaneous injection of dulaglutide (1·5 mg) or placebo. Randomisation was done by a computer-generated random code with stratification by site. All investigators and participants were masked to treatment assignment. Participants were followed up at least every 6 months for incident cardiovascular and other serious clinical outcomes. The primary outcome was the first occurrence of the composite endpoint of non-fatal myocardial infarction, non-fatal stroke, or death from cardiovascular causes (including unknown causes), which was assessed in the intention-to-treat population. This study is registered with ClinicalTrials.gov, number NCT01394952. FINDINGS: Between Aug 18, 2011, and Aug 14, 2013, 9901 participants (mean age 66·2 years [SD 6·5], median HbA1c 7·2% [IQR 6·6-8·1], 4589 [46·3%] women) were enrolled and randomly assigned to receive dulaglutide (n=4949) or placebo (n=4952). During a median follow-up of 5·4 years (IQR 5·1-5·9), the primary composite outcome occurred in 594 (12·0%) participants at an incidence rate of 2·4 per 100 person-years in the dulaglutide group and in 663 (13·4%) participants at an incidence rate of 2·7 per 100 person-years in the placebo group (hazard ratio [HR] 0·88, 95% CI 0·79-0·99; p=0·026). All-cause mortality did not differ between groups (536 [10·8%] in the dulaglutide group vs 592 [12·0%] in the placebo group; HR 0·90, 95% CI 0·80-1·01; p=0·067). 2347 (47·4%) participants assigned to dulaglutide reported a gastrointestinal adverse event during follow-up compared with 1687 (34·1%) participants assigned to placebo (p<0·0001). INTERPRETATION: Dulaglutide could be considered for the management of glycaemic control in middle-aged and older people with type 2 diabetes with either previous cardiovascular disease or cardiovascular risk factors. FUNDING: Eli Lilly and Company.

• MeSH
• cévní mozková příhoda prevence a kontrola   MeSH
• diabetes mellitus 2. typu komplikace   farmakoterapie   MeSH
• dvojitá slepá metoda MeSH
• glukagonu podobné peptidy analogy a deriváty   terapeutické užití   MeSH
• hypoglykemika terapeutické užití   MeSH
• imunoglobuliny - Fc fragmenty terapeutické užití   MeSH
• infarkt myokardu prevence a kontrola   MeSH
• kardiovaskulární nemoci mortalita   prevence a kontrola   MeSH
• lidé středního věku MeSH
• lidé MeSH
• rekombinantní fúzní proteiny terapeutické užití   MeSH
• senioři MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH
• randomizované kontrolované studie MeSH