GLP-1 analog attached to an antibody fragment that allows a weekly injection. Used in type 2 diabetes to lower glucose and reduce cardiovascular risk.
Regulatory status
Approved (FDA / EMA)
Family
GLP-1 receptor agonist (weekly)
Scientific evidence
High
Number of findings
1
Where it acts
Hormones and metabolism · Heart and blood
Also known as
dulaglutide, Trulicity, LY2189265
Regulatory status
FDA (US): Approved (2014, Trulicity) for type 2 diabetes in adults; in 2020 to reduce major cardiovascular events and in 2022 for children aged 10 years or older
EMA (EU): Approved (2014, Trulicity) for poorly controlled type 2 diabetes in adults and children aged 10 years or older
Dose
Type 2 diabetes: 0.75 mg subcutaneously once a week; it can be increased to 1.5 mg and, if needed, to 3 mg and 4.5 mg weekly in steps of at least 4 weeks (FDA/EMA label).
Safety
Nausea, vomiting, diarrhea, and reduced appetite, especially at the start. Risk of pancreatitis, gallbladder problems, and dehydration with kidney damage. Contraindicated with a personal or family history of medullary thyroid cancer or MEN2 (because of findings in rodents). Use with a medical prescription.
Interactions
It slows gastric emptying and may alter the absorption of oral drugs. Greater risk of hypoglycemia with insulin or sulfonylureas.
Differences between women and men
In REWIND, almost half of participants (46%) were women. The label advises against its use in pregnancy and recommends stopping it if pregnancy is planned, because of lack of data. View the study →
Effect by goal · level of evidence
Cardiovascular events in type 2 diabetes
reducesHighRCT (AA)in people
−12% cardiovascular events
REWIND trial with 9,901 people with type 2 diabetes, most without prior cardiovascular disease, and a median of more than 5 years. Heart attack, stroke, or cardiovascular death: 12.0% with dulaglutide vs 13.4% with placebo (HR 0.88).
It activates the GLP-1 receptor, an intestinal hormone. It increases insulin release only when glucose is high, suppresses glucagon, slows stomach emptying, and reduces appetite. Its attachment to an immunoglobulin fragment delays its elimination and allows one dose a week.
What the evidence says
In people
Cardiovascular events in type 2 diabetes. REWIND trial with 9,901 people with type 2 diabetes, most without prior cardiovascular disease, and a median follow-up of more than 5 years. Heart attack, stroke, or cardiovascular death: 12.0% with dulaglutide versus 13.4% with placebo (HR 0.88). PubMed 31189511