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Introduction
Diabetes is an increasingly prevalent metabolic disease associated with a wide range of serious complications. The current prevalence of diabetes in the European region has been estimated at approximately 60 million (10.3% of men and 9.6% of women aged 25 years and over) [1, 2], with estimates for France in the region of 7.4% (range: 6.1–9.1%, age-adjusted prevalence: 5.3%), equating to approximately 3.3 million diagnosed diabetes cases in 2015 [2]. A substantial proportion of these patients remain at suboptimal levels of glucose control, increasing the risk of diabetes-related complications [3, 4]. The life expectancy of patients with diabetes is reduced by up to 10 years compared to the general population, mainly due to the increased risk of cardiovascular death and stroke [5, 6]; in 2015, diabetes accounted for more than 26,000 deaths in France [2]. The majority of diabetes patients (approximately 90%) suffer from type 2 diabetes mellitus (T2DM) [2].
The high prevalence and socioeconomic consequences of T2DM make this disease a prominent public health issue. A 2010 study estimated the total statutory health insurance (SHI) expenditure on diabetes care in France at €17.7 billion. Of this, an annual spend of €2.5 billion was attributed to diabetes treatment and prevention of complications, €4.2 billion was attributed to the treatment of diabetes-related complications (with cardiovascular complications accounting for approximately 20% of this total), and a further €3.6 billion was attributed to the treatment of diabetes-related comorbidities [7]. According to the International Diabetes Federation (IDF) 7th Diabetes Atlas Report, in 2015, France had the sixth highest diabetes-related expenditure worldwide, which is expected to rise to approximately $19 billion (reported in 2015 international dollars) by 2040 [2]. Dulaglutide is a novel GLP-1 RA administered once weekly via a disposable auto-injection pen with a fixed dosage (1.5 mg). The efficacy and safety of dulaglutide 1.5 mg were established in the AWARD clinical trial program [8, 9, 10, 11, 12–13]. Dulaglutide is an alternative treatment option available for T2DM management. Available GLP-1 RAs in France currently include exenatide twice daily, liraglutide once daily, and exenatide once weekly (QW). Of the available formulations, the uptake of exenatide twice daily is low (based on MIDAS GLP-1 market share data) [14]. Dulaglutide has been shown to be superior to exenatide twice daily...