What is the recommended use and dosage of dulaglutide (Trulicity) for patients with type 2 diabetes?

From the Guidelines

Dulaglutide (Trulicity) is recommended for adults with type 2 diabetes as a once-weekly subcutaneous injection, typically starting at 0.75 mg and potentially increasing to 1.5 mg for enhanced glycemic control if needed. The medication should be injected in the abdomen, thigh, or upper arm, and can be administered at any time of day without regard to meals. Patients should rotate injection sites to prevent lipodystrophy.

Key Points to Consider

• Dulaglutide works by mimicking the incretin hormone GLP-1, which stimulates insulin secretion, suppresses glucagon release, slows gastric emptying, and reduces appetite, making it effective for both blood sugar control and weight management 1.
• Common side effects include nausea, vomiting, and diarrhea, which typically improve over time.
• Dulaglutide offers cardiovascular benefits and does not require dose adjustment for renal impairment, though it should be used cautiously in patients with severe gastrointestinal disease or a history of pancreatitis 1.

Administration and Dosage

• The initial dose is 0.75 mg once weekly, which can be increased to 1.5 mg once weekly if additional glycemic control is required 1.
• The medication should be administered via subcutaneous injection, and patients should be instructed on proper injection techniques and site rotation to minimize the risk of lipodystrophy.

Special Considerations

• Dulaglutide is contraindicated in patients with a history of serious hypersensitivity reaction to the drug, pregnancy or breastfeeding, severe renal impairment or end-stage renal failure, personal or family history of medullary thyroid cancer, or personal or family history of multiple endocrine neoplasia type 2 (MEN2) 1.
• Patients with prior gastric surgery, including bariatric surgery, should be cautioned about the potential for delayed gastric emptying, and the medication should be used with caution in patients with clinically meaningful gastroparesis.

From the FDA Drug Label

1 INDICATIONS AND USAGE TRULICITY® is indicated: As an adjunct to diet and exercise to improve glycemic control in adults and pediatric patients 10 years of age and older with type 2 diabetes mellitus To reduce the risk of major adverse cardiovascular events (cardiovascular death, non-fatal myocardial infarction, or non-fatal stroke) in adults with type 2 diabetes mellitus who have established cardiovascular disease or multiple cardiovascular risk factors.

2 DOSAGE AND ADMINISTRATION 2. 1 Adult Dosage The recommended starting dosage of TRULICITY is 0.75 mg injected subcutaneously once weekly. Increase the dosage to 1.5 mg once weekly for additional glycemic control. If additional glycemic control is needed, increase the dosage in 1.5 mg increments after at least 4 weeks on the current dosage. The maximum recommended dosage is 4.5 mg injected subcutaneously once weekly.

The recommended use and dosage of dulaglutide (Trulicity) for patients with type 2 diabetes is:

• Initial dosage: 0.75 mg injected subcutaneously once weekly
• Dosage increase: Increase to 1.5 mg once weekly for additional glycemic control, and further increase in 1.5 mg increments after at least 4 weeks on the current dosage
• Maximum dosage: 4.5 mg injected subcutaneously once weekly
• Administration: Administer once weekly, any time of day, with or without food, subcutaneously in the abdomen, thigh, or upper arm, rotating injection sites with each dose 2.

From the Research

Recommended Use of Dulaglutide

• Dulaglutide (Trulicity) is a once-weekly subcutaneously administered glucagon-like peptide-1 (GLP-1) receptor agonist approved for the treatment of adults with type 2 diabetes (T2D) as an adjunct to diet and exercise 3, 4.
• It is used to improve glycemic control in patients with T2D, and can be used as monotherapy or in combination with other antihyperglycemic agents, including metformin, sulfonylureas, pioglitazone, and insulin 3, 5.

Dosage of Dulaglutide

• The recommended dosage of dulaglutide is 0.75 mg or 1.5 mg once weekly, administered subcutaneously 5, 6.
• Dulaglutide 1.5 mg once weekly has been shown to be more effective than 0.75 mg once weekly in improving glycemic control and reducing body weight 3, 6.

Efficacy and Safety of Dulaglutide

• Dulaglutide has been shown to be effective in improving glycemic control, with significant reductions in HbA1c levels compared to placebo and active comparators, including metformin, sitagliptin, exenatide, and insulin glargine 3, 5, 6, 7.
• Dulaglutide has also been shown to have a favorable safety profile, with a low risk of hypoglycemia and gastrointestinal adverse events, including nausea, vomiting, and diarrhea, being the most commonly reported adverse events 3, 5, 6, 4.
• Dulaglutide may also have beneficial effects on body weight and cardiovascular outcomes, including a reduction in the risk of major adverse cardiac events (MACE) 6, 4.