Summary

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• Dulaglutide (Trulicity) is indicated as an adjunct to diet and exercise to improve glycemic control in adults and pediatric patients 10 years of age and older with type 2 diabetes mellitus, and to reduce the risk of major adverse cardiovascular events in adults with type 2 diabetes mellitus who have established cardiovascular disease or multiple cardiovascular risk factors.
• The review included a total of 24 studies from systematic reviews/meta-analyses.
• In patients with advanced chronic kidney disease (CKD) and end-stage kidney disease (ESKD), dulaglutide significantly reduces blood glucose levels, weight, cardiothoracic ratio, and pro-BNP but does not significantly decrease systolic blood pressure. It has gastrointestinal side effects like nausea and vomiting without increasing hypoglycemia risk.
• For cerebrovascular outcomes among a large population across randomized controlled trials (RCTs), dulaglutide shows overall reduction in nonfatal strokes, ischemic strokes, and composite ischemic stroke/TIA, especially beneficial for those with a shorter duration of diabetes or higher eGFR.
• Compared against other GLP-1 receptor agonists such as exenatide, liraglutide, and lixisenatide, semaglutide ranks higher than dulaglutide for HbA1c reduction and weight loss, while both show no significant difference in adverse events except gastrointestinal issues.
• Mixed results were found regarding neuroprotective effects on incident depression; some studies suggest potential benefits which require further confirmation through additional trials.
• Comparative efficacy analysis indicates tirzepatide outperforms dulaglutide for HbA1c reduction and weight loss, whereas insulin combinations are less effective compared to dulaglutide's favorable position within the broader GLP-1 RA context, particularly noted among Asian populations despite slightly increased hypoglycemic incidents needing more RCT evidence for long-term safety assessment.
• Adherence rates favor once-weekly agents like Trulicity over daily injections, highlighting dosing frequency's crucial role in influencing patient compliance thus supporting its use based on individual preferences alongside clinical considerations.