====== Dulaglutide ======

Dulaglutide is a long-acting, once-weekly GLP-1 receptor agonist used for Type 2 Diabetes and cardiovascular risk reduction.

Brand:
  * Trulicity

→ [[endocrine:glp1:start|GLP-1 Receptor Agonists Overview]]

===== Mechanism of Action =====

Dulaglutide activates the GLP-1 receptor.

Effects:

  * Increases glucose-dependent insulin secretion
  * Decreases glucagon secretion
  * Slows gastric emptying
  * Increases satiety
  * Promotes weight loss

Net clinical effects:

  * Decreases HbA1c
  * Reduces body weight
  * Reduces major adverse cardiovascular events

Low hypoglycemia risk unless combined with insulin or sulfonylureas.

===== Indications =====

==== Type 2 Diabetes Mellitus ====

  * Glycemic control
  * Cardiovascular risk reduction in high-risk patients

==== Atherosclerotic Cardiovascular Disease (ASCVD) ★ ====

Dulaglutide reduces:

  * Myocardial infarction
  * Stroke
  * Cardiovascular death

Particularly beneficial in patients with established ASCVD or multiple risk factors.

→ [[cardio:intro:start|Cardiovascular Modules]]

===== Major Trial =====

REWIND Trial:

  * Reduced major adverse cardiovascular events
  * Included many patients without established ASCVD
  * Demonstrated strong primary prevention benefit

===== Dosing =====

  * Once-weekly subcutaneous injection
  * No oral formulation
  * Gradual dose escalation improves tolerability

===== Adverse Effects =====

Common:

  * Nausea
  * Vomiting
  * Diarrhea
  * Early satiety

Serious (rare):

  * Pancreatitis
  * Gallbladder disease
  * Theoretical risk of medullary thyroid carcinoma

===== Contraindications =====

  * Personal or family history of medullary thyroid carcinoma
  * MEN2 syndrome
  * Severe gastrointestinal disease

Use caution in:

  * History of pancreatitis

===== Dulaglutide vs Other GLP-1 Agents =====

[[endocrine:glp1:exenatide|Exenatide]]

  * Shorter-acting formulations available

[[endocrine:glp1:liraglutide|Liraglutide]]

  * Daily injection
  * Strong ASCVD data (LEADER trial)

[[endocrine:glp1:semaglutide|Semaglutide]]

  * Greater weight loss
  * Oral option available

Dulaglutide:

  * Weekly dosing
  * Strong primary prevention data
  * Well tolerated

===== GLP-1 vs SGLT2 =====

Dulaglutide:

  * Strong ASCVD reduction
  * Modest weight loss
  * Minimal heart failure benefit

[[endocrine:sglt2:start|SGLT2 Inhibitors]]:

  * Strong heart failure benefit
  * Strong renal protection

===== Clinical Pearls =====

  * Weekly injection
  * Proven ASCVD benefit
  * Good primary prevention data
  * Low hypoglycemia risk
  * Not primary heart failure therapy

===== Related =====

  * [[endocrine:glp1:start|GLP-1 Receptor Agonists]]
  * [[endocrine:sglt2:start|SGLT2 Inhibitors]]
  * [[cardio:intro:start|Cardiovascular Modules]]