Dulaglutide as a Bridging Therapy Before Insulin for Diabetes Following Pancreatectomy on Congenital Hyperinsulinism.

Hyperinsulinism and postpancreatectomy diabetes (CHI/PPD) refers to diabetes following pancreatectomy to treat hypoglycemia due to congenital hyperinsulinism. Insulin therapy in CHI/PPD may sometimes be challenging because of glucagon deficiency and the dysfunction of the remaining β-cells. In a 16-year-old male patient with CHI/PPD and severe hypoglycemic brain damage, a dulaglutide trial was planned, because some biochemical indices suggested that he was not completely insulin-dependent. Other than transient appetite loss, no adverse events were observed. The patient's hemoglobin A1c level promptly decreased from 6.7% (SI: 49.7 mmol/mol) [reference range, 4.6-6.2% (SI: 26.8-44.3 mmol/mol)] to 5.7%, with temporary, but not persistent, improvement in endogenous insulin secretion. He has been free from exogenous insulin for more than 4 years under dulaglutide. In conclusion, in selected patients with CHI/PPD and reserved β-cell function, dulaglutide may serve as a bridging therapy before insulin introduction.