From the Guidelines
Dulaglutide is a glucagon-like peptide-1 (GLP-1) receptor agonist medication used primarily to treat type 2 diabetes, with a recommended starting dose of 0.75 mg once weekly, which can be increased to 1.5 mg weekly for additional glycemic control if needed. The medication is administered as a once-weekly subcutaneous injection using a pre-filled pen device, and it works by mimicking the action of the natural hormone GLP-1, which stimulates insulin secretion when blood sugar levels are high, slows gastric emptying, reduces glucagon secretion, and promotes satiety 1. These mechanisms help lower blood glucose levels while also often leading to weight loss, making it particularly beneficial for overweight or obese patients with diabetes. Common side effects include nausea, vomiting, diarrhea, and injection site reactions, which typically improve over time. Dulaglutide has also shown cardiovascular benefits in clinical trials, reducing the risk of major adverse cardiovascular events in patients with type 2 diabetes who have established cardiovascular disease or multiple risk factors 1. According to the most recent study, dulaglutide can be used if eGFR > 15 ml/min per 1.73 m², and it is recommended to reduce the risk of major adverse cardiovascular events in patients with type 2 diabetes who have established cardiovascular disease or multiple risk factors 1. It is also important to note that dulaglutide has been shown to have benefits in patients with chronic kidney disease, including reducing the risk of kidney disease progression and cardiovascular events 1. Overall, dulaglutide is a valuable treatment option for patients with type 2 diabetes, particularly those with established cardiovascular disease or multiple risk factors, and its use should be considered in the context of individual patient needs and medical history. Some key points to consider when prescribing dulaglutide include:
- Starting dose: 0.75 mg once weekly
- Titration: can be increased to 1.5 mg weekly for additional glycemic control if needed
- Administration: once-weekly subcutaneous injection using a pre-filled pen device
- Mechanism of action: mimics the action of the natural hormone GLP-1 to stimulate insulin secretion, slow gastric emptying, reduce glucagon secretion, and promote satiety
- Common side effects: nausea, vomiting, diarrhea, and injection site reactions
- Cardiovascular benefits: reduces the risk of major adverse cardiovascular events in patients with type 2 diabetes who have established cardiovascular disease or multiple risk factors
- Benefits in chronic kidney disease: reduces the risk of kidney disease progression and cardiovascular events.
From the FDA Drug Label
Dulaglutide is a human glucagon-like peptide-1 (GLP-1) receptor agonist The molecule is a fusion protein that consists of 2 identical, disulfide-linked chains, each containing an N-terminal GLP-1 analog sequence covalently linked to the Fc portion of a modified human immunoglobulin G4 (IgG4) heavy chain by a small peptide linker and is produced using mammalian cell (Chinese hamster ovary) culture The GLP-1 analog portion of dulaglutide is 90% homologous to native human GLP-1 (7-37).
Dulaglutide is a human glucagon-like peptide-1 (GLP-1) receptor agonist. It is a fusion protein produced using mammalian cell culture, with a molecular weight of approximately 63 kilodaltons. The GLP-1 analog portion of dulaglutide is 90% homologous to native human GLP-1 (7-37) 2.
- Key characteristics:
- Human glucagon-like peptide-1 (GLP-1) receptor agonist
- Fusion protein
- 90% homologous to native human GLP-1 (7-37)
- Molecular weight: approximately 63 kilodaltons
- Mechanism of action: Dulaglutide activates the GLP-1 receptor, leading to glucose-dependent insulin release, decreased glucagon secretion, and slowed gastric emptying 2.
- Pharmacokinetics: The pharmacokinetics of dulaglutide is similar between healthy subjects and patients with type 2 diabetes mellitus, with a time to maximum plasma concentration of 24 to 72 hours and an accumulation ratio of approximately 1.56 2.
From the Research
Definition and Mechanism of Action
- Dulaglutide is a glucagon-like peptide-1 (GLP-1) receptor agonist used for the management of hyperglycemia in adult patients with type 2 diabetes 3.
- It stimulates dose-dependent insulin secretion and reduces glucagon secretion, both in a glucose-dependent manner 3.
Efficacy and Safety
- Dulaglutide has been shown to be effective in reducing hemoglobin A1c (HbA1c) levels and promoting weight loss in patients with type 2 diabetes 4, 5.
- The most common adverse events associated with dulaglutide are transient and generally mild gastrointestinal disturbances 3, 5.
- Dulaglutide has been found to have a lower risk of hypoglycemia compared to other glucose-lowering agents 4, 5.
Clinical Use and Comparison to Other Agents
- Dulaglutide is administered once weekly and can be used as monotherapy or in combination with other antidiabetic agents, including metformin, sulfonylureas, and insulin 3, 6.
- Dulaglutide has been compared to other GLP-1 receptor agonists, such as liraglutide, and has been found to have a similar safety and efficacy profile 5.
- Dulaglutide has been shown to be non-inferior to liraglutide in terms of reducing HbA1c levels 3.