What is the recommended use and dosage of Dulaglutide (Trulicity) for type 2 diabetes treatment?

Dulaglutide (Trulicity) for Type 2 Diabetes Treatment: Recommended Use and Dosage

Dulaglutide is recommended as a once-weekly subcutaneous injection for type 2 diabetes, with a starting dose of 0.75 mg that can be titrated up to a maximum of 4.5 mg in adults, particularly for patients with established cardiovascular disease or high cardiovascular risk factors. 1

Indications

• Approved as an adjunct to diet and exercise to improve glycemic control in adults and pediatric patients 10 years and older with type 2 diabetes 1
• Indicated 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 who have established cardiovascular disease or multiple cardiovascular risk factors 1
• Particularly beneficial for patients with type 2 diabetes and established atherosclerotic cardiovascular disease where major adverse cardiovascular events (MACE) are the gravest threat 2

Dosage Recommendations for Adults

• Starting dose: 0.75 mg subcutaneously once weekly 1
• Titration: Increase to 1.5 mg once weekly for additional glycemic control 1
• Further titration: If additional glycemic control is needed, increase dosage in 1.5 mg increments after at least 4 weeks on the current dosage 1
• Maximum recommended dosage: 4.5 mg subcutaneously once weekly 1

Dosage Recommendations for Pediatric Patients

• Starting dose: 0.75 mg subcutaneously once weekly 1
• Maximum dose: 1.5 mg once weekly (after at least 4 weeks on the 0.75 mg dosage) 1

Administration Guidelines

• Administer once weekly, any time of day, with or without food 1
• Inject subcutaneously in the abdomen, thigh, or upper arm with rotation of injection sites 1
• When using with insulin, administer as separate injections (never mix) 1
• If a dose is missed, administer as soon as possible if there are at least 3 days (72 hours) until the next scheduled dose; otherwise, skip the missed dose 1

Specific Patient Populations for Consideration

• For patients with type 2 diabetes and established atherosclerotic cardiovascular disease, dulaglutide has shown significant benefit in reducing MACE 2
• Can be considered in patients without established cardiovascular disease but with high-risk indicators (age ≥55 years with coronary/carotid/lower extremity artery stenosis >50%, left ventricular hypertrophy, eGFR <60 mL/min/1.73m², or albuminuria) 2
• Beneficial in patients with chronic kidney disease (CKD), with evidence showing that GLP-1 receptor agonists reduce albuminuria and slow eGFR decline 2
• The decision to treat with dulaglutide to reduce MACE, heart failure hospitalization, cardiovascular death, or CKD progression should be considered independently of baseline HbA1c or individualized HbA1c target 2

Clinical Efficacy

• Significantly improves glycemic control with HbA1c reductions of approximately 1.3% after 6 months and 2.0% after 12 months of treatment 3
• Provides modest but significant weight reduction (approximately 2.0 kg at 6 months and 3.5 kg at 12 months) 3
• When added to SGLT2 inhibitor therapy, dulaglutide 1.5 mg reduces HbA1c by approximately 1.34% compared to 0.54% with placebo 4

Contraindications and Precautions

• Contraindicated in patients with personal or family history of medullary thyroid carcinoma (MTC) or Multiple Endocrine Neoplasia syndrome type 2 (MEN 2) 1
• Not recommended for patients with a history of pancreatitis 1
• Should not be used in patients with type 1 diabetes mellitus 1
• Not recommended in patients with severe gastrointestinal disease, including severe gastroparesis 1
• Common adverse events include gastrointestinal disturbances (nausea, vomiting, diarrhea), which are typically transient and mild 5, 4

Special Considerations

• For patients with financial barriers, consider that dulaglutide is a higher-cost medication compared to options like metformin, sulfonylureas, and human insulin 2
• In patients with chronic kidney disease, dulaglutide has demonstrated favorable outcomes and can be used when metformin and/or SGLT2 inhibitors are not achieving glycemic targets 2
• Low risk of hypoglycemia when used as monotherapy, but dose adjustment of concomitant insulin or insulin secretagogues may be needed to reduce hypoglycemia risk 2, 6

By following these recommendations, clinicians can appropriately prescribe dulaglutide to improve glycemic control and reduce cardiovascular risk in patients with type 2 diabetes.