P70 | Have we underestimated the power of GLP1-RA? A case report of middle-aged man with T2D and obesity

S. Gallo, N. Cimbalo, A. Natali | Department of Clinical and Experimental Medicine, University of Pisa; Laboratory of Metabolism, Nutrition, and Atherosclerosis, University of Pisa, Italy

Premises: Patients with type 2 diabetes who present with a HbA1c >86 mmol/mol are commonly treated with insulin therapy. However, the new therapies have made it possible to develop different approaches, especially when it’s associated with severe obesity. The combination of calories restriction and a non-insulin treatment, can lead to substantial reduction in Hb1Ac.
Description of the Case report: A 50-year-old man with obesity (IMC 39,7 Kg/m2), hypertension and a family history of diabetes, had an occasional fasting glucose of 142 mg/dl in 2021, which was not followed by further investigations. In March 2023, he came to visit with HbA1c 93 mmol/mol (10.7%), so we started a treatment with slow-release metformin and dulaglutide 0,75 mg/week. Returning in June 2023, he showed a slight weight loss (3 Kg), a significant reduction in HbA1c (52 mmol/mol, 6.9%), improved blood pressure control, leading to the suspension of antihypertensive therapy. At the October 2023 follow up, there was a further weight loss (IMC 36,6 Kg/m2) and a further improvement in glycemic control (HbA1c 39 mmol/mol, 5.7%), so metformin was discontinued.
Conclusions: In this case report, we demonstrate that calories restriction and weight loss are fundamental goals to pursue in obese patients with type 2 diabetes. The synergistic effect of lifestyle changes coupled with the initiation of a non-insulin therapy (metformin+dulaglutide) may lead to an unexpected reduction in Hb1Ac. Moreover, it is conceivable that the hypoglycemic effect of GLP1-RA is greater when the baseline Hb1Ac is higher.