From the Guidelines
Given your A1c has increased to 9.6 from 7.9 while on Trulicity 1.5mg weekly, I strongly recommend intensifying your diabetes management to reduce the risk of complications. To achieve this, you should consult your healthcare provider about either adding a second medication or possibly switching to a different GLP-1 receptor agonist, such as semaglutide (Ozempic), which can provide stronger glucose control 1. Options to consider include adding an SGLT-2 inhibitor like empagliflozin (Jardiance) or dapagliflozin (Farxiga), or metformin if you're not already taking it 1. Additionally, review your diet to reduce carbohydrate intake, increase physical activity to at least 150 minutes per week, and monitor your blood glucose more frequently to identify patterns. This rise in A1c indicates your current regimen isn't adequately controlling your blood sugar, which increases your risk for diabetes complications including heart, kidney, eye, and nerve damage. The goal is to bring your A1c below 7% to reduce these risks, as recommended by the American College of Physicians guidance statement on HbA1c targets for glycemic control with pharmacologic therapy in nonpregnant adults with type 2 diabetes mellitus 1. It's also important to consider the potential side effects and benefits of each medication, as well as your individualized glycemic goals and any comorbid conditions you may have. For example, metformin is a commonly used medication that is effective and safe, but it may cause gastrointestinal intolerance and increase the risk of vitamin B12 deficiency 1. Your healthcare provider can help you weigh the benefits and risks of each option and develop a personalized treatment plan to achieve your glycemic goals. Some key points to consider when discussing your treatment plan with your healthcare provider include:
- The importance of individualizing your glycemic goals based on your age, life expectancy, and comorbid conditions 1
- The potential benefits and risks of each medication, including the risk of hypoglycemia, weight gain, and other adverse effects 1
- The importance of monitoring your blood glucose regularly and adjusting your treatment plan as needed to achieve your glycemic goals 1
- The potential benefits of lifestyle modifications, such as reducing carbohydrate intake and increasing physical activity, in achieving your glycemic goals 1
From the Research
Glycemic Control with Trulicity
- The increase in A1c from 7.9 to 9.6 while taking Trulicity 1.5mg weekly may indicate a need for adjustment in treatment plan 2.
- A study on dulaglutide, the active ingredient in Trulicity, showed that it improved glycemic control and was well-tolerated as monotherapy in patients with early-stage type 2 diabetes 2.
- However, the study also noted that greater percentages of patients reached HbA1c targets <7.0% and ≤6.5% with dulaglutide 1.5 and 0.75 mg compared with metformin, suggesting that Trulicity may be effective in achieving glycemic goals 2.
Factors Affecting Glycemic Control
- Baseline characteristics, such as longer diabetes duration, female sex, non-white ethnicity, and self-funding or Medicaid coverage, may affect the achievement of target A1c levels 3.
- The use of continuous glucose monitoring (CGM) has been shown to improve glycemic control and reduce diabetes distress and hypoglycemic concerns 4.
- Time in range (TIR) and hyperglycemia metrics, such as TIR70-180, are highly correlated with each other but only moderately correlated with A1c 5.
Treatment Adjustments
- The study on basal insulin treatment noted that many patients require further insulin titration to achieve target A1c levels 3.
- The use of sodium-glucose cotransporter 2 inhibitors (SGLT2i) and metformin dual therapy has been shown to achieve HbA1c <8% in approximately 3 out of 5 patients, with African Americans having a lower likelihood of achieving this glycemic goal 6.
- Adjustments to the treatment plan, such as adding or modifying medications, may be necessary to achieve optimal glycemic control 2, 6.