The effects of dulaglutide in patients with type 2 diabetes

This article examined dulaglutide (Trulicity) in patients with type 2 diabetes (T2D). It found that dulaglutide was effective and tolerable. 

T2D is a progressive disease. T2D may be controlled at first by lifestyle changes, like diet and exercise. However, eventually at least one, and often more, drugs may be needed. Treatments include metformin (Glucophage) and sitagliptin (Januvia).

Dulaglutide is the newest glucagon-like peptide-1 receptor agonist (GLP-1 RA). Glucagon-like peptide 1 (GLP-1) is made in the intestines and released after a meal. GLP-1 stimulates the release of insulin (hormone needed to break down glucose) and inhibits the release of glucagon (hormone that raises blood glucose). These hormonal changes reduce blood glucose. GLP-1 also slows down the absorption of glucose from the intestines after a meal. GLP-1 RAs are injectable drugs that mimic the effects of GLP-1. Some GLP-1 RAs can be taken once a week, while others are needed daily.

Dulaglutide is injected just under the skin once a week. Other GLP-1 RAs are twice-daily exenatide (Byetta), once-weekly exenatide (Bydureon), and once-daily liraglutide (Victoza).

This study reviewed the safety and effectiveness of dulaglutide. The results of multiple other studies were compared.

Dulaglutide at any dose reduced HbA1c (average blood glucose over the last 3 months) more than metformin, exenatide, sitagliptin, and placebo (drug with no active effect). High doses of dulaglutide reduced HbA1c more than insulin, and about as much as liraglutide. Low doses of dulaglutide reduced HbA1c as much as insulin. A greater proportion of patients achieved HbA1c levels below 7% when taking dulaglutide than when taking metformin, exenatide, insulin, sitagliptin, or placebo.

Weight loss for dulaglutide at any dose was better than insulin, sitagliptin, and placebo. Weight loss for higher doses of dulaglutide was similar to metformin and exenatide, and less than for liraglutide. Weight loss for lower doses of dulaglutide was less than metformin and exenatide.

The most common side effects of dulaglutide were nausea, vomiting, and diarrhea. Patients taking higher doses of dulaglutide experienced more side effects than patients taking lower doses. Rates of nausea ranged from 7% to 28% depending on dose. Similar numbers of patients experienced side effects with metformin, and liraglutide. Side effects were more common with dulaglutide than insulin and sitagliptin.

Hypoglycemia (dangerously low blood glucose) occurred in fewer patients taking dulaglutide than insulin, and exenatide. Rates of hypoglycemia were similar for patients taking dulaglutide and metformin, and higher for patients taking dulaglutide than patients taking liraglutide and sitagliptin. 

The study concluded that dulaglutide was a safe and effective once-weekly treatment option for T2D.

The patients in the different studies received drugs other than dulaglutide. These drugs may have influenced the results of any of the studies included in the article.

Discuss the effectiveness of dulaglutide with your physician.