Trulicity (dulaglutide) is a prescription medicine licensed in the UK for treating type 2 diabetes mellitus in adults and children aged 10 years and over. As a glucagon-like peptide-1 (GLP-1) receptor agonist, it helps regulate blood sugar levels through multiple mechanisms, including stimulating insulin secretion and suppressing glucagon release. Administered as a convenient once-weekly subcutaneous injection, Trulicity is used alongside diet and exercise to improve glycaemic control, either alone when metformin is unsuitable or in combination with other diabetes medications. It is not indicated for type 1 diabetes or weight loss in people without diabetes.

What Is Trulicity Used For?

Trulicity (dulaglutide) is a prescription medicine licensed in the UK for the treatment of type 2 diabetes mellitus in adults and in adolescents and children aged 10 years and over. It belongs to a class of medications called glucagon-like peptide-1 (GLP-1) receptor agonists, which help regulate blood sugar levels through multiple mechanisms. The Medicines and Healthcare products Regulatory Agency (MHRA) has approved Trulicity as an adjunct to diet and exercise to improve glycaemic control.

Trulicity is typically prescribed when:

• As monotherapy when metformin is inappropriate due to intolerance or contraindications

• As combination therapy alongside other diabetes medications such as metformin, sulfonylureas, or SGLT2 inhibitors

• In combination with insulin therapy when additional blood glucose control is needed

The medication is administered as a once-weekly subcutaneous injection using a pre-filled pen device, making it more convenient than daily injections. The usual starting dose is 0.75mg once weekly, which may be increased to 1.5mg, 3.0mg or 4.5mg based on individual response.

NICE guidance (NG28) recommends GLP-1 receptor agonists like Trulicity for adults with type 2 diabetes as part of a triple therapy regimen when insulin is not acceptable, and when the person has:

• A BMI of 35 kg/m² or higher (adjust accordingly for people from Black, Asian and other minority ethnic groups) and specific psychological or other medical problems associated with obesity, or

• A BMI lower than 35 kg/m² and insulin would have significant occupational implications or weight loss would benefit other obesity-related comorbidities.

It is important to note that Trulicity is not indicated for type 1 diabetes or for the treatment of diabetic ketoacidosis. Additionally, Trulicity is not licensed for weight loss in people without type 2 diabetes. The medication should always be used as part of a comprehensive diabetes management plan that includes dietary modifications, regular physical activity, and ongoing monitoring of blood glucose levels. Patients should discuss with their GP or diabetes specialist whether Trulicity is an appropriate treatment option for their individual circumstances.

Who Can Take Trulicity in the UK

Trulicity is licensed for use in adults and in adolescents and children aged 10 years and over with type 2 diabetes mellitus. However, not everyone with type 2 diabetes is a suitable candidate for this medication, and healthcare professionals must carefully assess individual patient factors before prescribing.

The only formal contraindication to Trulicity is:

• Hypersensitivity to dulaglutide or any of the excipients in the formulation

Trulicity is not indicated for use in patients with:

• Type 1 diabetes mellitus

• Diabetic ketoacidosis

Special caution and medical supervision are required for patients with:

• Gastrointestinal disease: Trulicity is not recommended in patients with severe gastrointestinal disease, including gastroparesis (delayed stomach emptying), due to limited experience in this population

• Renal impairment: No dose adjustment is required across all levels of renal impairment, including end-stage renal disease. However, patients should be monitored during episodes of gastrointestinal adverse effects to prevent dehydration and acute kidney injury

• History of pancreatitis: GLP-1 receptor agonists have been associated with acute pancreatitis. Patients should be advised to seek urgent medical attention if they experience severe, persistent abdominal pain

• Diabetic retinopathy: Rapid improvements in glycaemic control may temporarily worsen diabetic eye disease

Pregnancy and breastfeeding considerations are particularly important. Trulicity should be avoided during pregnancy, and women should discontinue treatment at least one month before a planned pregnancy. Women of childbearing potential should use effective contraception during treatment. Trulicity should not be used during breastfeeding as it is unknown whether dulaglutide is excreted in human breast milk.

Patients taking Trulicity alongside insulin or sulfonylureas may have an increased risk of hypoglycaemia, and dose reductions of these medications may be necessary.

Elderly patients (aged 65 and over) can generally use Trulicity safely, with no dose adjustment typically required based on age alone. However, as renal function naturally declines with age, kidney function should be monitored regularly in older adults taking this medication.

If you experience any suspected side effects while taking Trulicity, report them via the MHRA Yellow Card Scheme (yellowcard.mhra.gov.uk or via the Yellow Card app).

Benefits Beyond Blood Sugar Control

Whilst Trulicity's primary indication is glycaemic control in type 2 diabetes, clinical trials have demonstrated several additional benefits that make it an attractive treatment option for many patients. These pleiotropic effects extend beyond simple blood sugar reduction and address multiple aspects of metabolic health.

Cardiovascular protection represents one of the most significant additional benefits. The REWIND trial (Researching Cardiovascular Events with a Weekly Incretin in Diabetes) demonstrated that Trulicity reduced the risk of major adverse cardiovascular events (MACE) — including cardiovascular death, non-fatal myocardial infarction, and non-fatal stroke — by 12% compared to placebo in patients with type 2 diabetes. This cardiovascular benefit was observed across a broad range of patients, including those with and without established cardiovascular disease. While this evidence is reflected in the product information, it's important to note that Trulicity's UK licence remains specifically for glycaemic control in type 2 diabetes.

Weight management is another notable benefit. Clinical studies have shown that patients taking Trulicity typically experience modest weight loss of approximately 2–3 kg over 26 weeks, though individual responses vary considerably depending on baseline weight, dose, and other factors. This weight reduction occurs through multiple mechanisms, including reduced appetite, delayed gastric emptying, and increased satiety. For patients with type 2 diabetes who are overweight or obese — which represents the majority of cases — this weight loss can improve insulin sensitivity and contribute to better overall metabolic health. However, Trulicity is not licensed for weight loss or obesity treatment in people without type 2 diabetes.

Blood pressure reduction has also been observed in clinical trials, with modest decreases in both systolic and diastolic blood pressure. Whilst Trulicity is not licensed as an antihypertensive medication, this additional benefit may be helpful for patients with both diabetes and hypertension.

It is important to emphasise that these benefits should be considered within the context of each patient's individual circumstances, and treatment decisions should be made collaboratively between patients and their healthcare team, taking into account the full range of available treatment options.

How Trulicity Works to Control Blood Sugar

Trulicity's mechanism of action centres on its role as a GLP-1 receptor agonist, mimicking the effects of the naturally occurring incretin hormone glucagon-like peptide-1. Understanding this pharmacological action helps explain both its therapeutic benefits and potential adverse effects.

The incretin system plays a crucial role in glucose homeostasis. When food is consumed, the intestines release incretin hormones, including GLP-1, which stimulate insulin secretion from pancreatic beta cells in a glucose-dependent manner. In people with type 2 diabetes, this incretin effect is diminished, contributing to inadequate insulin secretion and poor glycaemic control.

Dulaglutide, the active ingredient in Trulicity, is a long-acting GLP-1 receptor agonist that has been structurally modified to resist degradation by the enzyme dipeptidyl peptidase-4 (DPP-4), which normally breaks down natural GLP-1 within minutes. This modification allows Trulicity to maintain therapeutic levels for approximately one week, enabling once-weekly dosing.

Trulicity controls blood sugar through several complementary mechanisms:

• Glucose-dependent insulin secretion: Trulicity stimulates the pancreas to release insulin only when blood glucose levels are elevated, significantly reducing the risk of hypoglycaemia compared to medications like sulfonylureas

• Suppression of glucagon: It inhibits the release of glucagon, a hormone that raises blood glucose by promoting hepatic glucose production

• Delayed gastric emptying: By slowing the rate at which food leaves the stomach, Trulicity reduces post-meal glucose spikes

• Appetite regulation: Central nervous system effects contribute to reduced food intake and increased satiety

Following subcutaneous injection, Trulicity reaches maximum plasma concentrations within 48 hours, with steady-state levels achieved after 2–4 weeks of weekly dosing. The medication is primarily eliminated through protein catabolism rather than renal excretion, which explains why no dose adjustments are required across all levels of renal impairment, including end-stage renal disease. However, patients should be monitored during episodes of gastrointestinal adverse effects to prevent dehydration.

While the risk of hypoglycaemia is low when Trulicity is used alone, this risk increases when combined with insulin or sulfonylureas. Dose reductions of these medications may be necessary when starting Trulicity.

If a dose is missed, it should be administered as soon as possible if there are at least 3 days (72 hours) until the next scheduled dose. If less than 3 days remain, skip the missed dose and administer the next dose on the regularly scheduled day.

Patients should be aware that the full glycaemic benefits of Trulicity may take several weeks to become apparent, and HbA1c reductions are typically assessed after 3–6 months of treatment. Regular monitoring and follow-up with healthcare professionals remain essential to optimise diabetes management.

Frequently Asked Questions