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.
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
What the researchers 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.
Why it 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 numbers in context
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 the study worked
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.
Who was studied
291 Chinese adults with type 2 diabetes and HbA1c 7.0-11.0% on stable basal insulin glargine with metformin and/or acarbose
What this study cannot 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.
How to read the evidence
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.
When this study was published
Published in 2023, this is a recent trial contributing to the growing evidence base for GLP-1 + insulin combination therapy in Asian populations.
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.
Questions still open
- 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?
Common questions
What is dulaglutide and how does it work with insulin?
Does adding dulaglutide to insulin increase the risk of dangerously low blood sugar?
Read the original research
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
Citation
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