From the Guidelines
Trulicity (dulaglutide) and Januvia (sitagliptin) can be used together to control blood sugar in people with type 2 diabetes, as they work through different mechanisms. According to the most recent evidence 1, this combination may provide better glycemic control than either medication alone, especially for patients who haven't achieved target blood sugar levels on a single agent. Trulicity is a GLP-1 receptor agonist that stimulates insulin release and reduces glucagon secretion, while Januvia is a DPP-4 inhibitor that prevents the breakdown of incretin hormones. However, this combination should only be used under medical supervision, as it may increase the risk of hypoglycemia (low blood sugar), particularly if the patient is also taking other diabetes medications like sulfonylureas or insulin. Some key points to consider when using this combination include:
- Dosing typically involves Trulicity as a once-weekly injection (starting at 0.75 mg and potentially increasing to 1.5 mg) alongside daily oral Januvia (usually 100 mg once daily, though dose adjustments may be needed for kidney impairment) 1.
- Regular blood sugar monitoring is essential when using this combination.
- Side effects may include gastrointestinal issues like nausea or diarrhea.
- It's also important to note that dulaglutide, like other GLP-1 receptor agonists, has demonstrated evidence of cardiovascular benefit in large CV outcome trials 1, which can be an added advantage for patients with type 2 diabetes and cardiovascular disease. In terms of kidney function, no dose adjustment is required for dulaglutide 1, but sitagliptin dose adjustments may be needed for patients with kidney impairment, with a maximum dose of 50 mg daily for patients with an eGFR of 30-44 mL/min/1.73 m2 and 25 mg once daily for those with an eGFR of 15-29 mL/min/1.73 m2. Overall, the combination of Trulicity and Januvia can be a useful treatment option for patients with type 2 diabetes, but it should be used under medical supervision and with careful monitoring of blood sugar levels and kidney function.
From the Research
Compatibility of Trulicity and Januvia
- Trulicity (dulaglutide) is a glucagon-like peptide-1 (GLP-1) receptor agonist used to treat type 2 diabetes 2, 3.
- Januvia (sitagliptin) is a dipeptidyl peptidase-4 inhibitor also used to treat type 2 diabetes 4.
- There is evidence that dulaglutide can be used in combination with other antihyperglycaemic agents, including oral antihyperglycaemic drugs like sitagliptin 2, 3.
- In clinical trials, dulaglutide has been shown to be effective and generally well tolerated when used as monotherapy or add-on therapy to other antihyperglycaemic agents, including sitagliptin 2, 3, 5.
Efficacy and Safety
- The combination of dulaglutide and sitagliptin may provide improved glycemic control and weight reduction compared to using either medication alone 2, 3.
- The safety profile of dulaglutide is similar to other GLP-1 receptor agonists, with gastrointestinal symptoms being the most common adverse events 2, 3, 5.
- Sitagliptin has been shown to be generally well tolerated, with a low risk of hypoglycemia and no increased risk of cardiovascular events 4.