Dulaglutide (Trulicity)

What Is Dulaglutide?

Dulaglutide is a once-weekly injectable GLP-1 receptor agonist approved for adults and children aged 10 and older with type 2 diabetes. It is sold under the brand name Trulicity and is widely recognized for its convenient auto-injector and evidence-based cardiovascular benefits.

Mechanism of Action

As a GLP-1 analog, dulaglutide works by:

  • Enhancing insulin secretion in response to high blood glucose
  • Suppressing inappropriate post-meal glucagon release
  • Slowing gastric emptying, reducing food intake
  • Promoting satiety and appetite control

Indications

  • Improves glycemic control in adults and children ≥10 years with type 2 diabetes
  • Reduces the risk of major cardiovascular events in adults with type 2 diabetes and established cardiovascular disease or multiple CV risk factors
  • Not approved for weight loss or type 1 diabetes

Dosage & Administration

  • Administered once weekly via subcutaneous injection using a prefilled auto-injector
  • Starting dose: 0.75 mg once weekly
  • May be increased to 1.5 mg, 3.0 mg, or 4.5 mg based on clinical response
  • Can be taken at any time of day, with or without meals

Benefits

  • Reduces HbA1c by 1.0–1.5% on average
  • Modest weight loss (~2–4 kg)
  • Proven cardiovascular benefits (REWIND trial)
  • Simple weekly dosing and user-friendly injector
  • Approved for pediatric use in type 2 diabetes

Side Effects

  • Nausea (most common), especially during initial dose escalation
  • Diarrhea, vomiting, or abdominal pain
  • Fatigue, decreased appetite
  • Rare: pancreatitis, gallbladder issues, kidney function changes
  • Injection site reactions are uncommon due to the auto-injector design

Contraindications & Warnings

  • Personal or family history of medullary thyroid carcinoma (MTC)
  • Multiple Endocrine Neoplasia syndrome type 2 (MEN 2)
  • History of pancreatitis (caution)
  • Not recommended in patients with severe gastrointestinal disease

Clinical Evidence

  • REWIND Trial (2019): Dulaglutide reduced the risk of major adverse cardiovascular events (MACE) by 12% in people with or without previous cardiovascular disease.
  • Demonstrated long-term safety and consistent HbA1c reduction in diverse populations, including older adults and those with renal impairment.

Comparison to Other GLP-1 Agonists

  • Less potent weight loss than semaglutide or liraglutide
  • Comparable HbA1c reduction and cardiovascular protection
  • Extremely easy to use with a no-button, preloaded injector

Cost & Access

  • Covered by most insurance plans for type 2 diabetes
  • Manufacturer savings programs may help reduce cost
  • May require prior authorization for higher doses

Summary

Dulaglutide (Trulicity) offers a powerful, convenient option for type 2 diabetes management with once-weekly dosing and cardiovascular protection. Though its weight loss effects are more modest compared to some newer agents, it remains a top choice for ease of use and broad clinical applicability.

References

  1. Gerstein HC, et al. “Dulaglutide and Cardiovascular Outcomes in Type 2 Diabetes (REWIND).” NEJM. 2019.
  2. Trulicity Prescribing Information. FDA, Updated 2024.
  3. American Diabetes Association. Standards of Care in Diabetes—2024. Diabetes Care. 2024.
  4. US FDA Pediatric Approval Notice for Dulaglutide. 2022.