Dulaglutide
Trulicity
Manufactured by Eli Lilly · Subcutaneous injection (pre-filled single-dose pen)
Avg Weight Loss
~3-5% body weight (not FDA-approved for weight management; weight loss is a secondary benefit at diabetes doses)
Dosing
Once weekly
Brand Cost
$900-1,100
Compounded
Not widely compounded
How It Works
Dulaglutide consists of a GLP-1 analog covalently linked to a modified human IgG4 Fc fragment via a small peptide linker. This design reduces immunogenicity and slows clearance, enabling once-weekly dosing. It activates GLP-1 receptors to enhance glucose-dependent insulin secretion, suppress glucagon release, and slow gastric emptying.
Dosing & Titration
Dulaglutide
Titration Protocol
Start at 0.75mg weekly for at least 4 weeks, increase to 1.5mg. If additional glycemic control needed, may increase to 3mg after at least 4 weeks, then to 4.5mg after at least 4 weeks.
Common Side Effects
Serious Risks
Pancreatitis (rare)
Thyroid C-cell tumors (observed in rodent studies; relevance to humans unknown)
Hypoglycemia (when used with insulin or sulfonylureas)
Acute kidney injury
Serious allergic reactions
Gallbladder disease
Cost Comparison
Brand Name
$900-1,100
per month
Compounded
Not widely compounded
per month
Pharmacy Options
Brand (retail)
Insurance Coverage
Widely covered for Type 2 Diabetes by most commercial and Medicare Part D plans. Prior authorization may be required. Not approved or covered for weight management.
Pros & Cons
Advantages
- Once-weekly dosing with easy-to-use pre-filled pen
- Hidden needle design reduces injection anxiety
- Proven cardiovascular benefit (REWIND trial)
- Good insurance coverage for diabetes
- Well-tolerated GI side effect profile
Disadvantages
- Not FDA-approved for weight management
- Modest weight loss compared to semaglutide and tirzepatide
- Less potent A1C reduction than tirzepatide
- No oral formulation
- Declining market share as newer agents gain coverage
Clinical Evidence
Clinical Trial Programs
AWARD program (Type 2 Diabetes: AWARD 1-11), REWIND (cardiovascular outcomes trial)
award1
Superior A1C reduction vs exenatide once weekly (-1.51% vs -0.99%)
rewind
12% reduction in major adverse cardiovascular events. Notable: enrolled lower CV risk population than other GLP-1 trials.
Contraindications
- Personal or family history of medullary thyroid carcinoma (MTC)
- Multiple Endocrine Neoplasia syndrome type 2 (MEN 2)
- Known serious hypersensitivity to dulaglutide or any excipients
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