This 24-week open-label RCT (DIADEMA) compared subcutaneous dulaglutide (0.75 mg weekly) vs. basal-bolus insulin therapy in 80 adolescents (aged 10–18 years) with transfusion-dependent β-thalassaemia (TDT)-induced diabetes who were uncontrolled on metformin.
Dulaglutide significantly reduced glycaemic variability (CV: 39.45% → 35.05%; p<0.001) while insulin worsened it (CV: 39.85% → 43.26%; p<0.001); between-group standardised effect size for CV was 1.69 (95% CI 1.16–2.22). Dulaglutide also improved HbA1c, fructosamine, time-in-range, fasting C-peptide, total cholesterol, and serum ferritin vs. insulin (all p<0.05), with no serious adverse events or hypoglycaemia.
- Single-centre trial at one Egyptian hospital limits generalisability. - Open-label design introduces potential performance and detection bias, though outcome assessors were blinded. - Small sample (n=80) and short follow-up (24 weeks); authors describe findings as exploratory.
In adolescents with TDT-induced diabetes uncontrolled on metformin, weekly dulaglutide improved glycaemic control and variability better than basal-bolus insulin, with added potential benefits on iron load and lipids — consider it as an alternative to insulin in this population pending larger confirmatory trials.
