Dulaglutide

Unlike semaglutide (Wegovy) and liraglutide (Saxenda), dulaglutide is not licensed as a dedicated weight-management product. It is approved for type 2 diabetes and, in the US, for reducing cardiovascular events in adults with T2D. Weight loss does occur on treatment (averaging a few kilos in trials), and it is sometimes prescribed off-label for weight, but its head-to-head efficacy for that purpose is smaller than semaglutide 2.4 mg or tirzepatide.

The evidence base is robust. In type 2 diabetes, the AWARD programme (AWARD-1 through AWARD-11, 2014 onwards) established glycaemic efficacy against placebo, metformin, sitagliptin, exenatide, insulin glargine, liraglutide and others. AWARD-11 (Frias et al., Diabetes Care 2020) tested higher doses (3.0 mg and 4.5 mg) and showed dose-dependent improvements in HbA1c and weight compared with the 1.5 mg dose. The cardiovascular outcomes evidence comes from REWIND (Gerstein et al., Lancet 2019), which randomised 9,901 patients with type 2 diabetes (mostly without established cardiovascular disease) and followed them for a median of 5.4 years. Dulaglutide reduced the primary MACE composite by 12% (HR 0.88) versus placebo. Notably, REWIND was the first GLP-1 cardiovascular outcomes trial to enrol a majority of participants for primary prevention (only ~31% had established CVD), and the benefit appeared consistent across that population. The honest caveats: trials are sponsor-run (Eli Lilly), and head-to-head against semaglutide (SUSTAIN-7, 2018) showed greater HbA1c and weight reduction with semaglutide 1.0 mg. So: clearly effective and approved for diabetes and CV risk reduction, but not the strongest GLP-1 for weight or HbA1c lowering.

For information only, this is a prescription medicine and dosing must be set by a clinician, not by reading a webpage. Trulicity is given as a once-weekly subcutaneous injection from a single-dose pre-filled pen. The standard starting dose is 0.75 mg weekly; the usual maintenance dose is 1.5 mg weekly, with optional escalation to 3 mg and then 4.5 mg weekly for additional glycaemic control (per the post-AWARD-11 label expansion). No dose escalation is required for tolerability at the 0.75 mg starting dose. Self-dosing from unregulated suppliers is unsafe: the products are unverified, and prescriber oversight catches the contraindications below.

The commonest side effects are gastrointestinal: nausea, vomiting, diarrhoea, constipation and abdominal pain, typically worst in the first few weeks of treatment or after a dose increase, and easing over time. Most are mild to moderate; a minority of patients discontinue because of them. More serious risks on the label include pancreatitis (rare), gallbladder disease (cholelithiasis and cholecystitis), and acute kidney injury usually mediated by dehydration from vomiting. The FDA label carries a boxed warning for thyroid C-cell tumours based on rodent data; whether this translates to humans is unresolved, but the medicine is contraindicated in anyone with a personal or family history of medullary thyroid carcinoma or MEN 2 syndrome. Not for use in pregnancy or breastfeeding. Injection-site reactions are common but typically mild. The long half-life means that, unlike liraglutide, side effects can persist for a couple of weeks after stopping.