Dulaglutide
Overview
Dulaglutide is a long‑acting glucagon‑like peptide‑1 (GLP‑1) receptor agonist that helps regulate blood sugar by increasing insulin release when glucose levels are high, reducing glucagon secretion, and slowing gastric emptying. Its structure includes a fused Fc fragment, giving it a very long duration of action and enabling once‑weekly subcutaneous dosing. This provides convenience for patients and helps maintain stable glucose control compared to daily therapies.
Background and Date of Approval
Dulaglutide was developed by Eli Lilly and was first approved in 2014 for managing type 2 diabetes. Its molecular design links a GLP-1 analogue to an IgG4-Fc fragment, prolonging its half-life and reducing degradation. Over time, higher fixed doses have also been approved based on clinical data showing additional glycemic and weight benefits.
Uses
Dulaglutide is indicated as an adjunct to diet and exercise for improving glycemic control in adults with type 2 diabetes. It is also used to reduce the risk of major cardiovascular events such as heart attack or stroke in adults with type 2 diabetes who have established cardiovascular disease or multiple cardiovascular risk factors.
Administration
Dulaglutide is administered as a once‑weekly subcutaneous injection. The usual starting dose is 0.75 mg once weekly, which can be increased to higher fixed doses such as 1.5 mg, 3.0 mg, or 4.5 mg depending on clinical response and patient needs. Dosing can be done at any time of day, with or without food, and injection sites may include the abdomen, thigh, or upper arm.
Side Effects
Common side effects include gastrointestinal symptoms such as nausea, diarrhea, vomiting, abdominal pain, and decreased appetite. Patients may also experience fatigue and mild injection-site reactions.
Warnings
More serious risks include pancreatitis. There is a warning about potential thyroid C-cell tumors based on animal studies, so dulaglutide is contraindicated in patients with a personal or family history of medullary thyroid carcinoma or Multiple Endocrine Neoplasia type 2. Hypoglycemia risk increases when dulaglutide is used with insulin or insulin secretagogues.
Precautions
Because dulaglutide slows gastric emptying, it can affect the absorption of other oral medications, requiring monitoring or dose adjustment. It should be used cautiously in patients with a history of pancreatitis. Theoretical risk of thyroid C-cell tumors means it is not recommended for patients with high thyroid risk.
Expert Tips
Educate patients on the once‑weekly injection schedule and proper injection technique. Monitor for gastrointestinal side effects, which often improve over time or with dose stability. Evaluate thyroid risk before starting, and advise patients to report neck swelling or persistent throat symptoms. In patients using other glucose-lowering agents, particularly insulin or sulfonylureas, adjust doses and monitor glucose to mitigate hypoglycemia. Regular follow-up helps assess efficacy, tolerability, and need for dose adjustment.