Dulaglutide

Dulaglutide is a long-acting, once-weekly GLP-1 receptor agonist used for Type 2 Diabetes and cardiovascular risk reduction.

Brand:

• Trulicity

→ GLP-1 Receptor Agonists Overview

Dulaglutide activates the GLP-1 receptor.

Effects:

• Increases glucose-dependent insulin secretion
• Decreases glucagon secretion
• Slows gastric emptying
• Increases satiety
• Promotes weight loss

Net clinical effects:

• Decreases HbA1c
• Reduces body weight
• Reduces major adverse cardiovascular events

Low hypoglycemia risk unless combined with insulin or sulfonylureas.

• Glycemic control
• Cardiovascular risk reduction in high-risk patients

Dulaglutide reduces:

• Myocardial infarction
• Stroke
• Cardiovascular death

Particularly beneficial in patients with established ASCVD or multiple risk factors.

→ Cardiovascular Modules

REWIND Trial:

• Reduced major adverse cardiovascular events
• Included many patients without established ASCVD
• Demonstrated strong primary prevention benefit

• Once-weekly subcutaneous injection
• No oral formulation
• Gradual dose escalation improves tolerability

Common:

• Nausea
• Vomiting
• Diarrhea
• Early satiety

Serious (rare):

• Pancreatitis
• Gallbladder disease
• Theoretical risk of medullary thyroid carcinoma

• Personal or family history of medullary thyroid carcinoma
• MEN2 syndrome
• Severe gastrointestinal disease

Use caution in:

• History of pancreatitis

Exenatide

• Shorter-acting formulations available

Liraglutide

• Daily injection
• Strong ASCVD data (LEADER trial)

Semaglutide

• Greater weight loss
• Oral option available

Dulaglutide:

• Weekly dosing
• Strong primary prevention data
• Well tolerated

Dulaglutide:

• Strong ASCVD reduction
• Modest weight loss
• Minimal heart failure benefit

SGLT2 Inhibitors:

• Strong heart failure benefit
• Strong renal protection

• Weekly injection
• Proven ASCVD benefit
• Good primary prevention data
• Low hypoglycemia risk
• Not primary heart failure therapy

• GLP-1 Receptor Agonists
• SGLT2 Inhibitors
• Cardiovascular Modules