GLP-1 Receptor Agonist
FDA Approved

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.

Trulicity (Type 2 Diabetes)

Dosing & Titration

Dulaglutide

0.75mg 1.5mg 3mg 4.5mg

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

Common Nausea Common Diarrhea Common Vomiting Common Abdominal pain Common Decreased appetite Common Dyspepsia Common Fatigue

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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