Can Trulicity (dulaglutide) cause urinary tract infections (UTIs)?

Trulicity (Dulaglutide) and Urinary Tract Infections

Trulicity (dulaglutide) is not associated with an increased risk of urinary tract infections (UTIs) based on current evidence.

Unlike SGLT2 inhibitors (such as dapagliflozin) which have been linked to increased UTI risk due to their mechanism of causing glucosuria, Trulicity works through a different pathway as a GLP-1 receptor agonist and does not cause glucose excretion in urine.

Mechanism of Action and UTI Risk

• Trulicity (dulaglutide) is a GLP-1 receptor agonist that works by:

  • Enhancing glucose-dependent insulin secretion
  • Suppressing glucagon secretion
  • Slowing gastric emptying
  • Reducing appetite

• This contrasts with SGLT2 inhibitors which:

  • Prevent glucose reabsorption in the proximal tubules
  • Induce urinary glucose excretion (glucosuria)
  • Create an environment favorable for bacterial growth in the urinary tract 1, 2

Evidence on Diabetes Medications and UTI Risk

SGLT2 Inhibitors and UTIs

• SGLT2 inhibitors have been associated with increased UTI risk:
  • Dapagliflozin showed slightly increased UTI rates (5.7% with 5mg dose vs. 3.7% with placebo) 2
  • A case report described E. coli septicemia in a patient with urinary stasis after starting dapagliflozin 1
  • Drug-drug interactions between SGLT2 inhibitors and other medications may further increase UTI risk 3

GLP-1 Receptor Agonists (including Trulicity)

• No evidence in the provided literature suggests that Trulicity or other GLP-1 receptor agonists increase UTI risk
• The European Association of Urology guidelines on urological infections do not list GLP-1 receptor agonists as risk factors for UTIs 4

Risk Factors for UTIs in Diabetic Patients

Patients with diabetes have higher UTI risk regardless of medication choice due to:

• Impaired immune function
• Glucosuria (in poorly controlled diabetes)
• Autonomic neuropathy affecting bladder function
• Incomplete bladder emptying
• Urinary stasis 5, 6

Clinical Implications

If a patient with diabetes develops UTIs:

1. Consider established risk factors:

   • Urinary tract obstruction
   • Incomplete bladder emptying
   • Vesicoureteral reflux
   • Diabetes control
   • Catheterization 4, 5

2. Evaluate medication regimen:

   • SGLT2 inhibitors may need reassessment if recurrent UTIs occur
   • No need to discontinue Trulicity based on UTI concerns

3. For UTI treatment in diabetic patients:

   • Obtain urine culture before starting antibiotics
   • Consider 7-14 day treatment course (longer if male with possible prostatitis)
   • First-line options include trimethoprim-sulfamethoxazole, nitrofurantoin, or fosfomycin 4, 5

Conclusion

While diabetes itself increases UTI risk, and SGLT2 inhibitors may further elevate this risk through glucosuria, there is no evidence suggesting Trulicity (dulaglutide) increases UTI risk. If a patient on Trulicity develops UTIs, other risk factors should be investigated rather than attributing the infection to this medication.