AWARD-6 ties weekly dulaglutide with daily liraglutide

A clinical trial called AWARD-6 found that dulaglutide, an injection taken once a week, worked as well as liraglutide, an injection taken once a day, at lowering blood sugar in people with type 2 diabetes ^[1]. The result mattered because it showed patients did not have to accept worse blood sugar control in exchange for fewer injections.

The trial enrolled 599 adults with type 2 diabetes who were already taking metformin but still had blood sugar levels above target ^[1]. Researchers randomly assigned 299 people to dulaglutide at 1.5 mg once a week and 300 people to liraglutide at 1.8 mg once a day, and the study ran at 62 sites in nine countries between June 2012 and November 2013 ^[1]. It was open-label, meaning patients and doctors knew which drug each person was taking, and it was funded by Eli Lilly and Company, the maker of dulaglutide ^[1].

After 26 weeks, A1C, a blood test that reflects average blood sugar over about three months, dropped by 1.42 percentage points in the dulaglutide group and 1.36 percentage points in the liraglutide group ^[1]. The difference between the two groups was small, just 0.06 percentage points, and the study's statistical analysis confirmed dulaglutide was noninferior to liraglutide, meaning it was not meaningfully worse ^[1]. Liraglutide did produce slightly more weight loss, according to the trial summary ^[1].

Side effects were similar between the two drugs. Nausea occurred in 20% of the dulaglutide group versus 18% of the liraglutide group, diarrhea occurred in 12% of each group, and vomiting occurred in 7% of the dulaglutide group versus 8% of the liraglutide group ^[1]. About 6% of patients in each group stopped treatment because of side effects ^[1]. No cases of severe low blood sugar were reported in either group ^[1].

Why it matters for patients

Before this trial, patients choosing between GLP-1 drugs faced a real trade-off: take a daily shot or accept a medication that might work less well. AWARD-6 showed that trade-off did not have to exist, at least for dulaglutide versus liraglutide at these doses ^[1]. For someone managing type 2 diabetes, a once-weekly injection can be easier to remember and may fit better into daily routines than a once-daily shot, without giving up meaningful blood sugar control ^[1].

The study also found that the two drugs caused similar rates of common digestive side effects, so people were not choosing between a more tolerable option and a less tolerable one, according to the trial results ^[1]. Weight loss was the one area where liraglutide had an edge, so patients whose priority is weight management alongside blood sugar control might weigh that difference differently than someone focused mainly on convenience ^[1].

The summary of this trial notes it