Dulaglutide
Dulaglutide (Trulicity) is a once-weekly injectable GLP-1 receptor agonist approved for type 2 diabetes and supported by large cardiovascular outcome trials. It lowers blood glucose and body weight modestly and reduces major cardiovascular events, backed by extensive clinical data.
01 Overview
Dulaglutide is a GLP-1 receptor agonist built as a fusion of a modified GLP-1 peptide to an antibody Fc fragment, giving it a long half-life suitable for once-weekly subcutaneous dosing. It is FDA- and EMA-approved for type 2 diabetes and, based on the REWIND trial, for reducing cardiovascular risk.
In clinical use dulaglutide reduces HbA1c and produces modest weight loss, generally less than semaglutide or tirzepatide. Gastrointestinal side effects are the main tolerability issue. It is one of the most thoroughly studied incretin drugs, with robust outcome data rather than surrogate endpoints alone.
02 Mechanism
Agonises the GLP-1 receptor, enhancing glucose-dependent insulin secretion, suppressing glucagon, slowing gastric emptying, and increasing satiety.
03 Dosing
| Tier | Dose | Route | Notes |
|---|---|---|---|
| Starting | 0.75 mg/wk | SubQ | Typical initiation dose. |
04 Effects
| Effect | Magnitude | Evidence | |
|---|---|---|---|
| Lowered blood glucose (HbA1c)Consistent HbA1c reduction in type 2 diabetes trials. | ~1-1.5% HbA1c | Clinical | |
| Weight lossModest weight reduction, less than newer agents. | ~2-4 kg | Clinical | |
| Reduced cardiovascular eventsLower rate of major adverse cardiovascular events in the REWIND trial. | Clinical |
05 Side effects
| Effect | Severity | Frequency | Evidence | Countermeasures |
|---|---|---|---|---|
| Nausea and GI upsetNausea, diarrhoea, and vomiting, especially during titration. | Moderate | Very common | Clinical | |
| Gallbladder diseaseIncreased risk of cholelithiasis, partly related to weight loss. | Moderate | Uncommon | Clinical | |
| Pancreatitis (rare)Acute pancreatitis reported rarely with GLP-1 agonists. | Severe | Rare | Clinical |