Can Trulicity (dulaglutide) be used for weight loss in patients with a history of obesity or overweight and comorbidities such as type 2 diabetes?

Can Trulicity Be Used for Weight Loss?

Trulicity (dulaglutide) is not FDA-approved for weight loss and should not be used as a primary weight loss medication, even though it produces modest weight reduction as a secondary benefit in patients with type 2 diabetes. 1

FDA-Approved GLP-1 Receptor Agonists for Weight Loss

The only GLP-1 receptor agonists specifically approved for weight management are:

• Saxenda (liraglutide 3.0 mg daily) - achieves mean weight loss of 5.24-6.1% 2
• Wegovy (semaglutide 2.4 mg weekly) - achieves mean weight loss of 14.9% at 68 weeks 2
• Zepbound (tirzepatide) - achieves superior weight loss of 20.9% at 72 weeks 2

Trulicity is specifically approved only for type 2 diabetes management, not obesity treatment. 2

Weight Loss Effects of Dulaglutide in Diabetes Patients

While dulaglutide does produce weight reduction, the magnitude is significantly less than FDA-approved weight loss medications:

• Dulaglutide demonstrates beneficial effects on body weight in patients with type 2 diabetes 3, with real-world evidence showing weight reduction in obese diabetic patients 4
• In clinical practice, one case report documented 40 kg weight loss over 6 months in a morbidly obese patient with type 2 diabetes (BMI 49.66 kg/m²), though this represents an exceptional response 5
• Weight reduction with dulaglutide is consistently modest compared to higher-dose semaglutide (2.4 mg) or tirzepatide 2

Clinical Decision Algorithm

For patients WITH type 2 diabetes seeking weight loss:

1. First-line: Tirzepatide 15 mg weekly - provides superior weight loss (20.9%) and glycemic control 2
2. Second-line: Semaglutide 2.4 mg weekly - if tirzepatide unavailable, provides 14.9% weight loss 2
3. Consider dulaglutide only if: Patient cannot tolerate or access tirzepatide/semaglutide, recognizing weight loss will be substantially less 2, 3

For patients WITHOUT diabetes seeking weight loss:

• Dulaglutide should NOT be used - it lacks FDA approval for this indication 2
• Use FDA-approved options: Wegovy (semaglutide 2.4 mg) or Zepbound (tirzepatide) for BMI ≥30 kg/m² or BMI ≥27 kg/m² with weight-related comorbidities 2

Important Clinical Considerations

When glucose-lowering medications are needed for type 2 diabetes patients with obesity:

• Prioritize medications that promote weight loss or are weight-neutral 1
• GLP-1 receptor agonists (including dulaglutide) are associated with weight loss, while insulin secretagogues, thiazolidinediones, and insulin cause weight gain 1
• Metformin, SGLT2 inhibitors, and GLP-1 receptor agonists should be preferred 1

Safety profile of dulaglutide:

• Generally well-tolerated with low inherent risk of hypoglycemia 3
• Common side effects include nausea (52%) and fatigue (28%) 4
• Risk of pancreatitis exists - cases of dulaglutide-induced acute pancreatitis have been reported 6
• Contraindicated in patients with personal or family history of medullary thyroid cancer or multiple endocrine neoplasia type 2 1

Common Pitfalls to Avoid

• Do not prescribe dulaglutide off-label for weight loss in non-diabetic patients - this lacks evidence-based support and FDA approval 2
• Do not assume all GLP-1 receptor agonists have equivalent weight loss efficacy - tirzepatide and semaglutide 2.4 mg are substantially more effective than dulaglutide 2
• Do not use dulaglutide when maximum weight loss is the primary goal - even in diabetic patients, tirzepatide or semaglutide 2.4 mg are superior choices 2
• Do not ignore insurance authorization requirements - weight loss indications require specific FDA-approved formulations (Wegovy, Zepbound) rather than diabetes formulations 2