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LY2189265

Phase 3

Diabetes Mellitus, Type 2 | Monoclonal antibody | Metabolic |Eli Lilly and Company|Last Updated: Jun 12, 2020

Success Probability
Approval Probability 71%
TA Base Rate26%
Adjusted LOA41%
ML RiskLOW_RISK
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Market & Valuation
rNPV $3.2B
Market Size $9.4B
Revenue Basis $1.6B
Competitors 6
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Trial Design
RandomizedDouble-BlindCONTROLLEDDMCBiomarker
Total Trials18
Total Enrollment8,059
FDA Designations
No designations recorded
Clinical Trials (18)
NCT IDTitlePhaseStatusEnrollmentVelocityDesignStartCompletionLast UpdatedSitesCountries
NCT03495102A Study of the Efficacy and Safety of Dulaglutide (LY2189265) in Participants With Type 2 DiabetesPHASE3 COMPLETED 1,842Apr 5, 2018Oct 10, 2019Jun 12, 2020208 United States, Argentina +14
NCT02152371A Study of Dulaglutide (LY2189265) in Participants With Type II DiabetesPHASE3 COMPLETED 300May 1, 2014Oct 1, 2015Sep 25, 201940 United States, Czechia +5
NCT01191268A Study in Participants With Type 2 Diabetes Mellitus (AWARD-4)PHASE3 COMPLETED 884Nov 1, 2010Sep 1, 2012Oct 8, 2014101 United States, Argentina +14
NCT01126580A Study in Participants With Type 2 Diabetes Mellitus (AWARD-3)PHASE3 COMPLETED 807May 1, 2010Jun 1, 2012Jan 16, 201591 United States, Argentina +17
NCT01064687A Study in Participants With Type 2 Diabetes MellitusPHASE3 COMPLETED 978Feb 1, 2010May 1, 2012Jan 26, 201589 United States, Argentina +2
NCT01075282A Study in Participants With Type 2 Diabetes Mellitus (AWARD-2)PHASE3 COMPLETED 810Feb 1, 2010Nov 1, 2012Jan 16, 201578 Argentina, Australia +18
NCT01149421A Study of the Effect of LY2189265 on Blood Pressure and Heart Rate in Type 2 DiabetesPHASE2 COMPLETED 755Jun 1, 2010Jan 1, 2012Feb 2, 201576 United States, Argentina +6
NCT01001104A Study of LY2189265 in Japanese Patients With Type 2 DiabetesPHASE2 COMPLETED 145Oct 1, 2009Dec 1, 2010Sep 28, 20156 Japan
NCT00734474A Study of LY2189265 Compared to Sitagliptin in Participants With Type 2 Diabetes Mellitus on MetforminPHASE2 COMPLETED 1,202Aug 1, 2008Jul 1, 2012Apr 20, 201599 United States, Canada +11
NCT01667900A Study of Dulaglutide in Chinese ParticipantsPHASE1 COMPLETED 58Aug 1, 2012Jun 1, 2014Mar 7, 20161 China
NCT01524770A Study to Compare the Effect of Giving Dulaglutide Using an Auto-injector Versus a Manual SyringePHASE1 COMPLETED 50Mar 1, 2012Jun 1, 2012Oct 22, 20141 United States
NCT01432938A Study of the Effect of Dulaglutide on the Action of Warfarin in Healthy ParticipantsPHASE1 COMPLETED 28Sep 1, 2011Dec 1, 2011Oct 7, 20141 United States
NCT01436201A Study of the Effect of Dulaglutide on How Body Handles Digoxin in Healthy ParticipantsPHASE1 COMPLETED 24Sep 1, 2011Nov 1, 2011Oct 7, 20141 United States
NCT01408888A Study of LY2189265 and Sitagliptin in Participants With Type 2 DiabetesPHASE1 COMPLETED 29Aug 1, 2011Apr 1, 2012Oct 7, 20143 United States
NCT01324388A Study of the Effect of LY2189265 on Two Blood Pressure DrugsPHASE1 COMPLETED 51Mar 1, 2011Aug 1, 2011Oct 8, 20143 United States
NCT01300260Effect of LY2189265 on Insulin Secretion in Response to Intravenous GlucosePHASE1 COMPLETED 32Feb 1, 2011Aug 1, 2011Oct 7, 20141 Germany
NCT01253304A Single Dose Study of LY2189265 in Subjects With Varying Degrees of Hepatic (Liver) ImpairmentPHASE1 COMPLETED 26Nov 1, 2010Nov 1, 2011Oct 7, 20142 Germany, Hungary
NCT01215968A Study to Evaluate the Effect of LY2189265 on the Speed at Which Food and Drink Leaves the Stomach in Patients With Type 2 Diabetes MellitusPHASE1 COMPLETED 38Sep 1, 2010Jul 1, 2011Oct 7, 20141 United Kingdom
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Study Endpoints
Primary Endpoints
Change in Hemoglobin A1c (HbA1c) From Baseline
Baseline, Week 36

HbA1c is measured to identify average plasma glucose concentration over prolonged periods of time. The Least Squares (LS) mean was estimated from a mixed-effects model with repeated measures (MMRM) that included the independent variables:Baseline + Pooled Country + Treatment + Time + Treatment\*Time (Type III sum of squares).

Change From Baseline to 28 Weeks in Hemoglobin A1c (HbA1c)
Baseline, 28 Weeks

HbA1c is a form of hemoglobin that is measured primarily to identify the average plasma glucose concentration over prolonged periods of time. Least-squares (LS) mean and standard error (SE) changes from baseline in HbA1c at 28 weeks were measured using mixed model regression and restricted maximum likelihood (REML) with treatment, pooled country, visit, and treatment-by -visit interaction as fixed effects, baseline as covariate, and participant as a random effect.

Change From Baseline to 26-week Endpoint in Glycosylated Hemoglobin (HbA1c)
Baseline, 26 weeks

Least Squares (LS) means of change from baseline were calculated using analysis of covariance (ANCOVA) adjusted by treatment, country, baseline metformin, and baseline HbA1c.

Change From Baseline to 26 Weeks Endpoint in Glycosylated Hemoglobin (HbA1c)
Baseline, 26 weeks

Least squares (LS) means were calculated using analysis of covariance (ANCOVA) with country and treatment as fixed effects and baseline HbA1c as a covariate.

Change From Baseline to 52 Weeks Endpoint in Glycosylated Hemoglobin (HbA1c)
Baseline, 52 weeks

Least Squares (LS) means were calculated using analysis of covariance (ANCOVA) with country and treatment as fixed effects and baseline HbA1c as a covariate.

Change From Baseline to 16 Weeks in Mean 24-hour Systolic Blood Pressure (SBP)
Baseline, 16 weeks

Mean 24-hour systolic blood pressure (SBP) was measured by using a 24-hour ambulatory blood pressure monitoring (ABPM) device attached to the participant's nondominant arm. Ambulatory blood pressure measurements were recorded every 20 minutes during the daytime (0700 to 2200 hours) and every 30 minutes during the nighttime hours (2200 to 0700), as preprogrammed into the device. For statistical analyses, diurnal hours were defined as 0800 to 2100 and nocturnal hours were defined as 0000 to 0600. Least Squares (LS) means were calculated using mixed model repeated measures (MMRM) adjusting for baseline, pooled sites, treatment, visit, treatment-by-visit interaction, and the stratified variable of diagnosis of hypertension.

Change From Baseline in Glycosylated Hemoglobin (HbA1c) at 12 Weeks
Baseline, 12 weeks

Change in HbA1c from baseline following 12 weeks of therapy (that is, HbA1c at week 12 minus HbA1c at baseline). Changes in HbA1c were analyzed by a mixed model repeated measures (MMRM) model that included dose, pre-study therapy, body mass index (BMI) group at baseline, baseline value, visit, and dose\*visit, where the participant was treated as a random effect.

Glycosylated Hemoglobin (HbA1c) Change From Baseline
Baseline, 52 weeks

Least squares (LS) means were calculated using analysis of covariance (ANCOVA) and last observation carried forward (LOCF) imputation with country and treatment as fixed effects and baseline HbA1c as a covariate.

Pharmacokinetics: Maximum Concentration (Cmax) of Dulaglutide
Pre-dose and 12, 24, 48, 72, 96, 168, and 336 hours post-dose

Pharmacokinetic parameters were assessed on Day 1 in Part A and Days 1 and 22 in Part B.

Pharmacokinetics: Time of Maximum Observed Concentration (Tmax) of Dulaglutide
Pre-dose and 12, 24, 48, 72, 96, 168, and 336 hours post-dose

Pharmacokinetic parameters were assessed on Day 1 in Part A and Days 1 and 22 in Part B.

Pharmacokinetics: Area Under the Concentration-time Curve From Time Zero to 336 Hours Postdose (AUC[0-336]) of Dulaglutide
Pre-dose and 12, 24, 48, 72, 96, 168, and 336 hours post-dose

Pharmacokinetic parameters were assessed on Day 1 in Part A and Days 1 and 22 in Part B.

Pharmacokinetics: Half-life of Dulaglutide
Pre-dose and 12, 24, 48, 72, 96, 168, and 336 hours post-dose

Pharmacokinetic parameters were assessed on Day 1 in Part A and Days 1 and 22 in Part B.

Pharmacokinetics: Area Under the Concentration Curve (AUC[0-336]) for Dulaglutide
Predose to 336 hours postdose
Pharmacokinetics: Maximum Concentration (Cmax) for Dulaglutide
Predose to 336 hours postdose
Pharmacokinetics: Area Under the Concentration Versus Time Curve (AUC) of R-warfarin and S-warfarin
Predose (warfarin) and up to 144 hours postdose on Day 1 for Treatment 1 (warfarin alone) and on Day 3 for Treatment 2 (warfarin in combination with dulaglutide)

Area under the concentration versus time curve (AUC) from zero to infinity was determined from plasma concentrations of the S- and R- enantiomers of warfarin.

Pharmacokinetics: Maximum Observed Drug Concentration (Cmax) of R-warfarin and S-warfarin
Predose (warfarin) and up to 144 hours postdose on Day 1 for Treatment 1 (warfarin alone) and on Day 3 for Treatment 2 (warfarin in combination with dulaglutide)
Pharmacokinetics: Time to Maximum Concentration (Tmax) of R-warfarin and S-warfarin
Predose (warfarin) and up to 144 hours postdose on Day 1 for Treatment 1 (warfarin alone) and on Day 3 for Treatment 2 (warfarin in combination with dulaglutide)
Pharmacokinetics: Area Under the Concentration Versus Time Curve (AUC) of Digoxin
Predose (Digoxin) and up to 24 hours postdose on Days 7, 10, and 17
Pharmacokinetics: Maximum Observed Drug Concentration (Cmax) of Digoxin
Predose (Digoxin) and up to 24 hours postdose on Days 7, 10, and 17
Pharmacokinetics: Time of Maximum Observed Drug Concentration (Tmax) of Digoxin
Predose (Digoxin) and up to 24 hours postdose on Days 7, 10, and 17
Pharmacokinetics: Area Under the Concentration Versus Time Curve (AUC) of Sitagliptin
Predose and up to 24 hours postdose on Day 4, Day 6, and Day 13 of Treatment 2

Area under the sitagliptin pharmacokinetic (PK) concentration versus time curve (AUC \[0-tau\]) during one dosing interval (24 hours) is summarized.

Pharmacokinetics: Maximum Observed Drug Concentration (Cmax) of Sitagliptin
Predose and up to 24 hours postdose on Day 4, Day 6, and Day 13 of Treatment 2
Pharmacokinetics, Area Under the Concentration Curve (AUC) of Lisinopril
Day -1, Day 3, Day 24 of Part 1
Pharmacokinetics, Maximum Concentration (Cmax) of Lisinopril
Day -1, Day 3, Day 24 in Part 1
Mean, 24-hour Heart Rate (Collected by Ambulatory Blood Pressure Monitoring [ABPM]) in Response to Co-administration of LY2189265 and Metoprolol
Day -1, Day 4, Day 7 of Treatment 2 in Part 2
Mean, 24-hour Blood Pressure (Collected by Ambulatory Blood Pressure Monitoring [ABPM]) in Response to Co-administration of LY2189265 and Metoprolol
Day -1, Day 4, Day 7 of Treatment 2 in Part 2
Maximum Insulin Concentration (Cmax) - First Phase Response
0-10 minutes after dextrose bolus on Day 3 postdose

On Day 1 of each treatment period, all participants (healthy or with type 2 diabetes mellitus \[T2DM\]) received a single subcutaneous dose of either LY2189265 or placebo. On Day 3 of each treatment period, participants underwent a 6-hour insulin infusion, followed by an intravenous (IV) dextrose 50% bolus to stimulate insulin secretion. Three hours later, participants were administered a second dextrose bolus, followed by an infusion of 20% dextrose and, 15 minutes after the start of the 20% dextrose infusion, a 1-mg glucagon bolus was administered. Maximum plasma insulin concentration from 0 to 10 minutes (INSCmax\[0-10\]) following the first dextrose bolus (the first phase response) was corrected for baseline, where baseline was the mean of the insulin concentrations obtained between -30 and 0 minutes relative to the first dextrose bolus.

Area Under the Insulin Concentration-time Curve (AUC) - First Phase Response
0-10 minutes after dextrose bolus on Day 3 postdose

On Day 1 of each treatment period, all participants (healthy or with type 2 diabetes mellitus \[T2DM\]) received a single subcutaneous dose of either LY2189265 or placebo. On Day 3 of each treatment period, participants underwent a 6-hour insulin infusion, followed by an intravenous (IV) dextrose 50% bolus to stimulate insulin secretion. Three hours later, participants were administered a second dextrose bolus, followed by an infusion of 20% dextrose and, 15 minutes after the start of the 20% dextrose infusion, a 1-mg glucagon bolus was administered. Area under the plasma insulin concentration time curve from 0 to 10 minutes (INSAUC\[0-10\]) following the first dextrose bolus (the first phase response) was corrected for baseline, where baseline was the mean of the insulin concentrations obtained between -30 and 0 minutes relative to the first dextrose bolus.

Maximum Insulin Concentration (Cmax) - Second Phase Response
10-180 minutes after dextrose bolus on Day 3 postdose

On Day 1 of each treatment period, all participants (healthy or with type 2 diabetes mellitus \[T2DM\]) received a single subcutaneous dose of either LY2189265 or placebo. On Day 3 of each treatment period, participants underwent a 6-hour insulin infusion, followed by an intravenous (IV) dextrose 50% bolus to stimulate insulin secretion. Three hours later, participants were administered a second dextrose bolus, followed by an infusion of 20% dextrose and, 15 minutes after the start of the 20% dextrose infusion, a 1-mg glucagon bolus was administered. Maximum plasma insulin concentration from 10 to 180 minutes (INSCmax\[10-180\]) following the first dextrose bolus (the second phase response) was corrected for baseline, where baseline was the mean of the insulin concentrations obtained between -30 and 0 minutes relative to the first dextrose bolus.

Insulin Area Under the Curve (AUC) - Second Phase Response
10-180 minutes after dextrose bolus on Day 3 post dose

On Day 1 of each treatment period, all participants (healthy or with type 2 diabetes mellitus \[T2DM\]) received a single subcutaneous dose of either LY2189265 or placebo. On Day 3 of each treatment period, participants underwent a 6-hour insulin infusion, followed by an intravenous (IV) dextrose 50% bolus to stimulate insulin secretion. Three hours later, participants were administered a second dextrose bolus, followed by an infusion of 20% dextrose and, 15 minutes after the start of the 20% dextrose infusion, a 1-mg glucagon bolus was administered. Area under the plasma insulin concentration time curve from 10 to 180 minutes (INSAUC\[10-180\]) following the first dextrose bolus (the second phase response) was corrected for baseline, where baseline was the mean of the insulin concentrations obtained between -30 and 0 minutes relative to the first dextrose bolus.

Pharmacokinetics: Maximum Observed Concentration (Cmax)
Predose to 336 hours postdose

This measure was calculated using non-compartmental analysis techniques.

Pharmacokinetics: Time of Maximum Concentration (Tmax)
Predose to 336 hours postdose

This measure was calculated using non-compartmental analysis techniques.

Pharmacokinetics: Area Under the Concentration Versus Time Curve From Time Zero to the Last Quantifiable Concentration (AUC[0-tlast])
Predose to 336 hours postdose

This measure was calculated using non-compartmental analysis techniques.

Pharmacokinetics: AUC From Time Zero to Infinity (AUC[0-infinity])
Predose to 336 hours postdose

This measure was calculated using non-compartmental analysis techniques.

Pharmacokinetics: Apparent Terminal Elimination Half-life (t1/2)
Predose to 336 hours postdose

The half life associated with the terminal rate constant is summarized. This measure was calculated using non-compartmental analysis techniques.

Pharmacokinetics: Apparent Total Plasma Clearance (CL/F)
Predose to 336 hours postdose

The apparent total body clearance of drug calculated after extra vascular administration is summarized. This measure was calculated using non-compartmental analysis techniques.

Pharmacokinetics: Apparent Volume of Distribution (Vz/F)
Predose to 336 hours postdose

The apparent volume of distribution during the terminal phase after extra vascular administration is summarized. This measure was calculated using non-compartmental analysis techniques.

Time Required for 50% of Radioactivity To Be Emptied From the Stomach by Scintigraphy
Days 3, 10,17, 24 and 31

After at least 8 hours fasting, participants received a radiolabeled breakfast containing technetium-99m-tin colloid (99mTc-tin colloid). After which serial anterior and posterior scintigraphy images were taken. Data presented are the time required for 50% of radioactivity to be emptied from stomach. The results presented are Geometric Least Squares (LS) Mean. LS Mean values were controlled for weeks.

Secondary Endpoints
Change in Body Weight From Baseline
Baseline, Week 36
Percentage of Participants Achieving HbA1c Target <7.0%
Week 36
Change in Fasting Serum Glucose (FSG) From Baseline
Baseline, Week 36
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Study Design & Arms
AllocationRANDOMIZED
MaskingDOUBLE
ModelPARALLEL
PurposeTREATMENT
Treatment Arms
ArmTypeDescription
Dulaglutide 1.5 mgACTIVE_COMPARATORDulaglutide 1.5 mg administered subcutaneously (SC) once a week.
Dulaglutide 3 mgEXPERIMENTALDulaglutide 3 mg administered SC once a week.
Dulaglutide 4.5 mgEXPERIMENTALDulaglutide 4.5 mg administered SC once a week.
Dulaglutide + Insulin GlargineEXPERIMENTAL1.5 milligrams (mg) dulaglutide administered subcutaneously (SQ) once weekly for 28 weeks. Titrated insulin glargine administered SQ once daily for 28 weeks. Participants who are taking metformin should remain on stable doses.
Placebo + Insulin GlarginePLACEBO_COMPARATORPlacebo administered SQ once weekly for 28 weeks. Titrated insulin glargine administered SQ once daily for 28 weeks. Participants who are taking metformin should remain on stable doses.
1.5 mg LY2189265EXPERIMENTALLY2189265 (Dulaglutide): 1.5 milligrams (mg), subcutaneous (SC), once weekly for 52 weeks Insulin Lispro: dose titration based on blood glucose measures, subcutaneous (SC), thrice daily (after each meal) for 52 weeks
0.75 mg LY2189265EXPERIMENTALLY2189265 (Dulaglutide): 0.75 milligrams (mg), subcutaneous (SC), once weekly for 52 weeks Insulin Lispro: dose titration based on blood glucose measures, subcutaneous (SC), thrice daily (after each meal) for 52 weeks
Insulin GlargineACTIVE_COMPARATORInsulin Glargine: dose titration based on blood glucose measures, subcutaneous (SC), once daily for 52 weeks Insulin Lispro: dose titration based on blood glucose measures, subcutaneous (SC), thrice daily (after each meal) for 52 weeks
MetforminACTIVE_COMPARATORMetformin: 500 milligrams per day (mg/day), orally, for Week 1; 1000 mg/day, orally, for Week 2; 1500 mg/day, orally, for Week 3; 2000 or at least 1500 mg/day, orally, for Weeks 4 through Week 52 Placebo: subcutaneously (SC), once weekly for 52 weeks
ExenatideACTIVE_COMPARATORExenatide: 5 micrograms (mcg), subcutaneous (SC), twice daily for 4 weeks, followed by 10 mcg, SC, twice daily for 48 weeks Metformin: at least 1500 milligrams per day (mg/day), oral, for 52 weeks Pioglitazone: at least 30 mg/day, oral, for 52 weeks
PlaceboPLACEBO_COMPARATORPlacebo: subcutaneous (SC), once weekly for 26 weeks LY2189265 (Dulaglutide): After 26 weeks, participants were randomized to receive either 0.75 milligrams (mg) or 1.5 mg, SC, once weekly for an additional 26 weeks (from week 26 through week 52). Metformin: at least 1500 milligrams per day (mg/day), oral, for 52 weeks Pioglitazone: at least 30 mg/day, oral, for 52 weeks
LY2189265 1.5 mgEXPERIMENTALLY2189265 (Dulaglutide): 1.5 milligrams (mg), subcutaneous (SC), once weekly for 78 weeks Metformin: at least 1500 milligrams per day (mg/day), oral, for 78 weeks Glimepiride: at least 4 mg/day, oral, for 78 weeks
LY2189265 0.75 mgEXPERIMENTALLY2189265 (Dulaglutide): 0.75 milligrams (mg), subcutaneous (SC), once weekly for 78 weeks Metformin: at least 1500 milligrams per day (mg/day), oral, for 78 weeks Glimepiride: at least 4 mg/day, oral, for 78 weeks
1.5 milligram (mg) LY2189265EXPERIMENTALLY2189265: 1.5 milligram (mg), subcutaneous (SC), once weekly (QW)
0.75 milligram (mg) LY2189265EXPERIMENTALLY2189265: 0.75 milligram (mg), subcutaneous (SC), once weekly (QW)
0.5 mg LY2189265EXPERIMENTAL -
0.25 mg LY2189265EXPERIMENTAL -
3.0 mg LY2189265EXPERIMENTALLY2189265 (Dulaglutide): 3.0 milligrams (mg), subcutaneous (SC) injection, once weekly for up to 104 weeks Placebo: tablet, administered orally, once daily for up to 104 weeks Metformin: at least 1500 milligrams per day (mg/day), administered orally for up to 104 weeks
2.0 mg LY2189265EXPERIMENTALLY2189265 (Dulaglutide): 2.0 milligrams (mg), subcutaneous (SC) injection, once weekly for up to 104 weeks Placebo: tablet, administered orally, once daily for up to 104 weeks Metformin: at least 1500 milligrams per day (mg/day), administered orally for up to 104 weeks
1.0 mg LY2189265EXPERIMENTALLY2189265 (Dulaglutide): 1.0 milligrams (mg), subcutaneous (SC) injection, once weekly for up to 104 weeks Placebo: tablet, administered orally, once daily for up to 104 weeks Metformin: at least 1500 milligrams per day (mg/day), administered orally for up to 104 weeks
SitagliptinACTIVE_COMPARATORSitagliptin: 100-milligrams (mg) tablet, administered orally, once daily for 104 weeks Placebo: solution, subcutaneous (SC) injection, once weekly for 104 weeks Metformin: at least 1500 milligrams per day (mg/day), administered orally for 104 weeks
Placebo/Sitagliptin (Baseline Through 104 Weeks)PLACEBO_COMPARATORPlacebo: solution, subcutaneous (SC) injection, once weekly for 104 weeks Placebo: tablet, administered orally, once daily for 26 weeks Sitagliptin: after 26 weeks, 100-milligrams (mg) tablet, administered orally, once daily for 78 weeks Metformin: at least 1500 milligrams per day (mg/day), administered orally for 104 weeks
0.5 mg Dulaglutide (Part A-Healthy)EXPERIMENTAL0.5 milligrams (mg) dulaglutide administered once subcutaneously (SQ) to healthy participants in 1 of 3 treatment periods
0.75 mg Dulaglutide (Part A-Healthy)EXPERIMENTAL0.75 mg dulaglutide administered once SQ to healthy participants in 1 of 3 treatment periods
1.5 mg Dulaglutide (Part A-Healthy)EXPERIMENTAL1.5 mg dulaglutide administered once SQ to healthy participants in 1 of 3 treatment periods
Placebo (Part A-Healthy)PLACEBO_COMPARATORPlacebo administered once SQ to healthy participants in 1 of 3 treatment periods
0.5 mg Dulaglutide (Part B-T2DM)EXPERIMENTAL0.5 mg dulaglutide administered to participants with Type 2 diabetes mellitus (T2DM) once weekly SQ for 4 weeks
0.75 mg Dulaglutide (Part B-T2DM)EXPERIMENTAL0.75 mg dulaglutide administered to participants with T2DM once weekly SQ for 4 weeks
1.5 mg Dulaglutide (Part B-T2DM)EXPERIMENTAL1.5 mg dulaglutide administered to participants with T2DM once weekly SQ for 4 weeks
Placebo (Part B-T2DM)PLACEBO_COMPARATORPlacebo administered to participants with T2DM once weekly SQ for 4 weeks
Manual syringeACTIVE_COMPARATORDulaglutide: Single dose of 1.5 milligrams (mg) dulaglutide administered subcutaneously (SC) by manual syringe in one of two study periods separated by a 28-day minimum washout period.
Auto-injectorEXPERIMENTALDulaglutide: Single dose of 1.5 milligrams (mg) dulaglutide administered subcutaneously (SC) by auto-injector in one of two study periods separated by a minimum 28-day washout period
Warfarin first, then Dulaglutide + WarfarinEXPERIMENTALA single, 10-milligram (mg) dose of warfarin administered orally on Day 1 (Treatment 1). There was a washout period of at least 24 days between treatment periods. Then a single, 1.5-mg dose of dulaglutide administered subcutaneously on Day 1, followed by a single, 10-mg dose of warfarin administered orally on Day 3 (Treatment 2).
Dulaglutide + Warfarin first, then WarfarinEXPERIMENTALA single, 1.5-mg subcutaneous dose of dulaglutide on Day 1, followed by a single, 10-mg oral dose of warfarin on Day 3 (Treatment 2). There was a washout period of at least 24 days between treatment periods. Then a single, 10-mg oral dose of warfarin on Day 1 (Treatment 1).
Digoxin + DulaglutideEXPERIMENTALDigoxin: Two 0.5-milligram (mg) doses, oral, 12 hours apart on Day 1 (1 mg total on Day 1); 0.25 mg, oral, once daily on Day 2 to Day 17. Dulaglutide (LY2189265): 1.5 mg, subcutaneous injection, once on Day 8 and once on Day 15.
LY2189265, Sitagliptin + LY2189265EXPERIMENTALA single 1.5-milligram (mg) dose of LY2189265 administered subcutaneously (Treatment 1). There was a washout period of at least 21 days before crossing over and receiving 100 mg of sitagliptin administered orally, once daily for 18 days in combination with two separate single 1.5-mg doses of LY2189265 administered subcutaneously, immediately prior to the sitagliptin doses on Day 5 and Day 12 (Treatment 2).
Sitagliptin + LY2189265, LY2189265EXPERIMENTAL100 mg of sitagliptin administered orally, once daily for 18 days in combination with two separate single 1.5-mg doses of LY2189265 administered subcutaneously, immediately prior to the sitagliptin doses on Day 5 and Day 12 (Treatment 2). There was a washout of at least 21 days before crossing over and receiving a single 1.5 mg dose of LY2189265 administered subcutaneously (Treatment 1).
LY2189265 + LisinoprilEXPERIMENTALLY2189265 (dulaglutide): 1.5 milligrams (mg), subcutaneous (SC), on Days 1, 8, 15, and 22 of Part 1 of the study. Lisinopril: Dose as prescribed by participant's established course of therapy, oral, daily dosing throughout Part 1 of the study.
Placebo + LisinoprilPLACEBO_COMPARATORPlacebo: 1.5 milligrams (mg), subcutaneous (SC), on Days 1, 8, 15, and 22 of Part 1 of the study. Lisinopril: Dose as prescribed by participant's established course of therapy, oral, daily dosing throughout Part 1 of the study.
LY2189265 (Treatment 1)/Metoprolol + LY2189265 (Treatment 2)EXPERIMENTALLY2189265 (dulaglutide): 1.5 milligrams (mg), subcutaneous (SC), on Day 1 of Treatment 1 and on Day 5 of Treatment 2 in Part 2 of the study. Metoprolol: 100 mg, oral, on Days 1 through 7 of Treatment 2 in Part 2 of the study. There was a washout period of at least 21 days between the LY2189265 and metoprolol doses of each treatment period (Day 1 of Treatment 1 to Day 1 of Treatment 2 in Part 2 of the study).
Metoprolol + LY2189265 (Treatment 2)/LY2189265 (Treatment 1)EXPERIMENTALLY2189265 (dulaglutide): 1.5 milligrams (mg), subcutaneous (SC), on Day 5 of Treatment 2 and on Day 1 of Treatment 1 in Part 2 of the study. Metoprolol: 100 mg, oral, on Days 1 through 7 of Treatment 2 in Part 2 of the study. There was a washout period of at least 21 days between the LY2189265 and metoprolol doses of each treatment period (Day 7 of Treatment 2 to Day 1 of Treatment 1 in Part 2 of the study).
LY2189265 then PlaceboEXPERIMENTALLY2189265 (Dulaglutide) then Placebo: A single 1.5 milligram (mg) subcutaneous (SC) injection of LY2189265 on Day 1 in Period 1, followed by a single SC injection of Placebo on Day 1 in Period 2. On Day 3 of each period, participants underwent a 6-hour insulin infusion, followed by an intravenous (IV) dextrose bolus (0.3 gram/kilogram \[g/kg\] over approximately 2 minutes). Three hours later, participants were administered a second IV dextrose bolus of 25 g of 50% dextrose or a suitably adjusted dose according to glycemic status (20 g of 50% dextrose for participants with 3-hour glucose between 5.2 and 10 millimole/liter \[mmol/L\] or 15 g of 50% dextrose for participants with 3-hour glucose \>10 mmol/L), followed by a 20% dextrose at the set infusion rate of 600 milliliter/hour \[mL/h\] for 35 minutes. Fifteen minutes after the start of the 20% dextrose infusion, an IV 1-mg glucagon bolus was administered. There was a washout period of at least 28 days between Periods 1 and 2.
Placebo then LY2189265EXPERIMENTALPlacebo then LY2189265 (Dulaglutide): A single subcutaneous injection of Placebo on Day 1 in Period 1, followed by a single 1.5 milligrams (mg) subcutaneous injection of LY2189265 on Day 1 in Period 2. On Day 3 of each period, participants underwent a 6-hour insulin infusion, followed by an intravenous (IV) dextrose bolus (0.3 gram/kilogram \[g/kg\] over approximately 2 minutes). Three hours later, participants were administered a second IV dextrose bolus of 25 g of 50% dextrose or a suitably adjusted dose according to glycemic status (20 g of 50% dextrose for participants with 3-hour glucose between 5.2 and 10 millimole/liter \[mmol/L\] or 15 g of 50% dextrose for participants with 3-hour glucose \>10 mmol/L), followed by a 20% dextrose at the set infusion rate of 600 milliliter/hour \[mL/h\] for 35 minutes. Fifteen minutes after the start of the 20% dextrose infusion, an IV 1-mg glucagon bolus was administered. There was a washout period of at least 28 days between Periods 1 and 2.
Normal hepatic functionEXPERIMENTALLY2189265: A single, subcutaneous (SC) 1.5-milligram (mg) injection on Day 1 in participants with normal hepatic function
Mild hepatic impairmentEXPERIMENTALLY2189265: A single, SC 1.5-mg injection on Day 1 in participants with mild hepatic impairment (Child-Pugh A)
Moderate hepatic impairmentEXPERIMENTALLY2189265: A single, SC 1.5-mg injection on Day 1 in participants with moderate hepatic impairment (Child-Pugh B)
Severe hepatic impairmentEXPERIMENTALLY2189265: A single, SC-1.5 mg injection on Day 1 in participants with severe hepatic impairment (Child-Pugh C)
LY2189265EXPERIMENTALParticipants randomized to LY2189265 will receive once-weekly doses of LY2189265 on Weeks 2 to 5. 1.5 milligram (mg) LY2189265 will be administered by single subcutaneous injection into the skin of the abdominal wall. Participants regularly taking metformin will continue their normal dosing regimen throughout the study.
Interventions
NameTypeDescription
DulaglutideDRUGAdministered SC
PlaceboDRUGAdministered SQ
Insulin GlargineDRUGAdministered SQ
MetforminDRUGAdministered orally
LY2189265DRUG -
Insulin LisproDRUG -
Placebo (oral)DRUG -
Placebo (subcutaneous)DRUG -
ExenatideDRUG -
PioglitazoneDRUG -
GlimepirideDRUG -
SitagliptinDRUG -
Placebo solutionDRUG -
Placebo tabletDRUG -
WarfarinDRUGAdministered orally
DigoxinDRUGAdministered orally
MetoprololDRUGAdministered orally
LisinoprilDRUGAdministered orally
InsulinDRUGAdministered intravenously
GlucoseDRUGAdministered intravenously
GlucagonDRUGAdministered intravenously
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Eligibility Criteria
Age Range18 Years — N/A
SexALL
Healthy VolunteersNo
Study Sites208

Inclusion Criteria: * Have type 2 diabetes mellitus (T2DM) for at least 6 months * Have been treated with stable metformin dose for at least 3 months * Have HbA1c ≥7.5% and ≤11.0% at study entry * Have body mass index (BMI) ≥25 kilograms per meter squared (kg/m\^2) Exclusion Criteria: * Have type...

Countries:United StatesArgentinaAustriaCanadaGreeceHungaryIsraelItalyMexicoPolandPuerto RicoRomaniaRussiaSlovakiaSpainTaiwanCzechiaUnited KingdomAustraliaBelgiumBrazilDenmarkSwedenCroatiaFinlandFranceGermanyIndiaSouth AfricaSouth KoreaJapanChina
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