Adding Weekly Dulaglutide to Insulin Nearly Doubles Blood Sugar Improvement in Chinese Diabetes Patients
Adding once-weekly dulaglutide to basal insulin doubled the HbA1c reduction and helped 76% of Chinese T2DM patients reach target blood sugar levels without increasing hypoglycemia risk.
Quick Facts
What This Study Found
Adding once-weekly dulaglutide 1.5 mg to basal insulin glargine produced a 2.0% reduction in HbA1c from baseline at 28 weeks, compared to 1.1% with insulin glargine plus placebo — a highly significant difference of 1.0% (p<0.001). Notably, 75.9% of patients in the dulaglutide group achieved the target HbA1c below 7.0%, versus only 33.8% with placebo.
Dulaglutide also produced weight loss while the placebo group gained weight (difference: -1.2 kg, p<0.001), and fasting blood sugar dropped further with dulaglutide (difference: -0.8 mmol/L, p<0.001). Critically, hypoglycemia rates were similar between groups (29.2% vs. 31.3%), and no severe hypoglycemia events occurred in either group.
Key Numbers
n=291 · HbA1c reduction: -2.0% (dulaglutide) vs. -1.1% (placebo) · p<0.001 · 75.9% vs. 33.8% achieved HbA1c <7.0% · weight difference: -1.2 kg · fasting glucose difference: -0.8 mmol/L · hypoglycemia: 29.2% vs. 31.3% (NS) · zero severe hypoglycemia · 28-week treatment
How They Did This
This was a phase III, randomized, double-blind, placebo-controlled trial (AWARD-CHN3) in Chinese patients with T2DM. 291 patients with HbA1c 7.0-11.0% on stable basal insulin glargine with metformin and/or acarbose were randomized 1:1 to receive add-on dulaglutide 1.5 mg once weekly or placebo once weekly for 28 weeks. The primary endpoint was change from baseline in HbA1c at Week 28.
Why This Research Matters
Many patients with type 2 diabetes cannot achieve adequate blood sugar control with basal insulin alone. This trial demonstrates that adding the GLP-1 peptide drug dulaglutide to insulin is highly effective in Chinese patients — an important finding given that China has the world's largest diabetes population. The combination achieved target HbA1c in over three-quarters of patients without increasing hypoglycemia risk, while also producing weight loss instead of the weight gain typically seen with insulin dose escalation.
The Bigger Picture
China has over 140 million people with diabetes — the largest affected population globally. Demonstrating that GLP-1 agonists work effectively as add-on therapy to insulin in Chinese patients is clinically significant and supports broader adoption of this treatment strategy in Asia. The AWARD-CHN3 trial adds to the extensive AWARD clinical program for dulaglutide and reinforces the trend of combining GLP-1 drugs with basal insulin as a preferred intensification strategy over adding mealtime insulin.
What This Study Doesn't Tell Us
The trial was conducted exclusively in Chinese patients, so results may not generalize to all populations, though GLP-1 agonist efficacy has been well-established globally. The 28-week duration, while standard for diabetes trials, does not capture long-term outcomes. Only the 1.5 mg dose of dulaglutide was tested. All patients were also receiving metformin and/or acarbose, so the results reflect combination therapy settings.
Questions This Raises
- ?How do dulaglutide's results in Chinese patients compare to those seen in the broader global AWARD trials?
- ?Would longer treatment duration or higher dulaglutide doses produce even greater HbA1c reductions?
- ?Could this GLP-1 + basal insulin combination reduce the need for mealtime insulin entirely in this patient population?
Trust & Context
- Key Stat:
- 75.9% achieved target HbA1c <7.0% Over three-quarters of patients adding dulaglutide to basal insulin reached the diabetes treatment target, compared to only one-third with insulin plus placebo
- Evidence Grade:
- This study earns a strong evidence grade as a phase III, randomized, double-blind, placebo-controlled clinical trial — the gold standard for evaluating drug efficacy and safety. The sample size of 291 is adequate for the endpoints measured.
- Study Age:
- Published in 2023, this is a recent trial contributing to the growing evidence base for GLP-1 + insulin combination therapy in Asian populations.
- Original Title:
- Efficacy and safety of adding once-weekly dulaglutide to basal insulin for inadequately controlled type 2 diabetes in Chinese patients (AWARD-CHN3): A randomized, double-blind, placebo-controlled, phase III trial.
- Published In:
- Diabetes, obesity & metabolism, 25(12), 3690-3699 (2023)
- Authors:
- Wang, Weimin, Yan, Xin, Cheng, Zhifeng(5), Zhang, Qiqi, Wang, Rui, Deng, Yuying, Ma, Jianhua, Zhu, Dalong
- Database ID:
- RPEP-07520
Evidence Hierarchy
Participants are randomly assigned to treatment or placebo groups to test cause and effect.
What do these levels mean? →Frequently Asked Questions
What is dulaglutide and how does it work with insulin?
Dulaglutide (brand name Trulicity) is a GLP-1 receptor agonist given as a once-weekly injection. It works by stimulating insulin release when blood sugar is high, slowing stomach emptying, and reducing appetite. When added to basal insulin (which provides steady background insulin), dulaglutide addresses the post-meal blood sugar spikes that basal insulin alone can't fully control — while also promoting weight loss instead of the weight gain usually seen with more insulin.
Does adding dulaglutide to insulin increase the risk of dangerously low blood sugar?
No — in this trial, the rate of hypoglycemia (low blood sugar) was essentially the same whether patients added dulaglutide or placebo to their insulin (29.2% vs. 31.3%). No patients in either group experienced severe hypoglycemia. This is because GLP-1 drugs like dulaglutide only stimulate insulin release when blood sugar is elevated, reducing the risk of overshooting into dangerous lows.
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Cite This Study
https://rethinkpeptides.com/research/RPEP-07520APA
Wang, Weimin; Yan, Xin; Cheng, Zhifeng; Zhang, Qiqi; Wang, Rui; Deng, Yuying; Ma, Jianhua; Zhu, Dalong. (2023). Efficacy and safety of adding once-weekly dulaglutide to basal insulin for inadequately controlled type 2 diabetes in Chinese patients (AWARD-CHN3): A randomized, double-blind, placebo-controlled, phase III trial.. Diabetes, obesity & metabolism, 25(12), 3690-3699. https://doi.org/10.1111/dom.15263
MLA
Wang, Weimin, et al. "Efficacy and safety of adding once-weekly dulaglutide to basal insulin for inadequately controlled type 2 diabetes in Chinese patients (AWARD-CHN3): A randomized, double-blind, placebo-controlled, phase III trial.." Diabetes, 2023. https://doi.org/10.1111/dom.15263
RethinkPeptides
RethinkPeptides Research Database. "Efficacy and safety of adding once-weekly dulaglutide to bas..." RPEP-07520. Retrieved from https://rethinkpeptides.com/research/wang-2023-efficacy-and-safety-of
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Study data sourced from PubMed, a service of the U.S. National Library of Medicine, National Institutes of Health.
This study breakdown was produced by the RethinkPeptides research team. We analyze and report published research findings without making health recommendations. All interpretations are based solely on the published abstract and study data.