Dulaglutide vs insulin in adolescents with thalassaemia-induced diabetes: effect on metabolism and atherogenesis (DIADEMA).

Open-label randomised trial in 80 adolescents aged 10-18 with transfusion-dependent beta-thalassaemia diabetes uncontrolled on metformin. Dulaglutide 0.75 mg subcutaneous weekly vs basal-bolus insulin for 24 weeks. Primary endpoint glucose coefficient of variation fell from 39.45% to 35.05% with dulaglutide (p<0.001) and rose from 39.85% to 43.26% with insulin (p<0.001). Between-group standardised effect size 1.69 (95% CI 1.16-2.22). Dulaglutide also reduced time above range, fasting blood glucose, HbA1c, fructosamine, total cholesterol and serum ferritin, and raised fasting C-peptide and time in range (all p<0.05). No new safety signal reported.

Dulaglutide reduced glycaemic variability while insulin worsened it in adolescents with thalassaemia-induced diabetes.