From the Guidelines
Trulicity (dulaglutide) has a minimal risk for hypoglycemia when used alone, but the risk increases when combined with other diabetes medications like insulin or sulfonylureas. According to the most recent evidence from 1, GLP-1 receptor agonists, including dulaglutide, have a high glucose-lowering efficacy with minimal risk of hypoglycemia. However, when used in combination with other glucose-lowering medications, the risk of hypoglycemia increases.
Key Considerations
- The risk of hypoglycemia with Trulicity is lower when used alone, but increases when combined with insulin or sulfonylureas 1.
- To prevent hypoglycemia, it is essential to monitor blood sugar regularly, eat meals on schedule, and adjust medication doses as directed by a healthcare provider 1.
- If hypoglycemia occurs, treat it immediately with 15 grams of fast-acting carbohydrates, and recheck blood sugar after 15 minutes 1.
- For severe hypoglycemia, keep glucagon on hand, and seek medical attention if necessary 1.
Mechanism of Action
Trulicity works by stimulating insulin release when blood sugar is high and suppressing glucagon, which can increase hypoglycemia risk when combined with other glucose-lowering medications 1.
Recommendations
- Use Trulicity with caution when combined with other diabetes medications, and closely monitor blood sugar levels 1.
- Adjust medication doses as directed by a healthcare provider to minimize the risk of hypoglycemia 1.
- Educate patients on the signs and symptoms of hypoglycemia, and provide guidance on treatment and prevention 1.
From the FDA Drug Label
Table 3: Incidence (%) of Hypoglycemia in Adult Patients with Type 2 Diabetes Mellitus in Placebo-Controlled Trials Placebo TRULICITY 0.75 mg TRULICITY 1.5 mg Add-on to Metformin (26 weeks) N=177 N=302 N=304 Hypoglycemia with a glucose level <54 mg/dL 0% 0.3% 0.7% Severe hypoglycemia 0% 0% 0%
Hypoglycemia and Trulicity:
- The incidence of hypoglycemia with a glucose level <54 mg/dL was 0.3% and 0.7% for TRULICITY 0.75 mg and 1.5 mg, respectively, when used as an add-on to metformin.
- Severe hypoglycemia was not reported in these treatment groups.
- Hypoglycemia was more frequent when TRULICITY was used in combination with a sulfonylurea or insulin than when used with non-secretagogues 2.
- Key points:
- Hypoglycemia incidence varies depending on the treatment combination.
- Severe hypoglycemia is rare but can occur, especially when TRULICITY is co-administered with other diabetes medications.
- Patients should be monitored for signs and symptoms of hypoglycemia when using TRULICITY.
From the Research
Hypoglycemia and Trulicity
- Trulicity (dulaglutide) is a glucagon-like peptide-1 (GLP-1) receptor agonist that has been shown to have a low inherent risk of hypoglycemia 3, 4, 5, 6
- In clinical trials, dulaglutide was associated with a lower risk of hypoglycemia compared to insulin glargine 7 and other antihyperglycemic agents 6
- The mechanism of action of GLP-1 receptor agonists, including dulaglutide, minimizes the risk of hypoglycemia by stimulating insulin secretion only when glucose levels are elevated 5
Efficacy and Safety of Dulaglutide
- Dulaglutide has been shown to be effective in improving glycemic control, with significant reductions in HbA1c levels compared to control groups 3, 7, 4, 6
- The safety profile of dulaglutide is similar to other GLP-1 receptor agonists, with gastrointestinal symptoms (e.g. nausea, vomiting, and diarrhea) being the most frequently reported adverse events 3, 5
- Dulaglutide has also been associated with weight loss and a reduced risk of major adverse cardiac events (MACE) in patients with type 2 diabetes 7, 4
Comparison to Other Antihyperglycemic Agents
- Dulaglutide has been compared to other antihyperglycemic agents, including insulin glargine, metformin, and sitagliptin, and has been shown to be non-inferior or superior in terms of glycemic control and weight loss 3, 7
- The risk of hypoglycemia was lower with dulaglutide compared to insulin glargine and other antihyperglycemic agents 7, 6