Trulicity and Medical Weight Loss: How Treatment with Dulaglutide Works

What is Trulicity and how does it work in the body?

Trulicity contains the active substance dulaglutide and is used for the treatment of type 2 diabetes. It belongs to the drug class GLP-1 receptor agonists.

Dulaglutide mimics the effect of the body's own hormone GLP-1 (glucagon-like peptide-1), which is released from the intestine in connection with meals and contributes to the regulation of blood sugar and appetite. The body's natural hormone is normally broken down quickly, but dulaglutide is modified to have a longer duration of action, allowing for dosing once a week.

The treatment leads to several interacting effects:

• Improved blood sugar control: Dulaglutide stimulates insulin release in a glucose-dependent manner and reduces the release of glucagon, contributing to more stable blood sugar levels.
• Delayed gastric emptying: The emptying of the stomach is delayed, which can contribute to an increased feeling of fullness after a meal.
• Impact on appetite regulation: The medication acts centrally and can, in some patients, contribute to reduced appetite and lower energy intake.

These effects work together to improve glycemic control in people with type 2 diabetes. Some weight loss may occur, but the medication is not primarily approved for the treatment of obesity.

Medication from Eli Lilly: Purpose and approved indication

Trulicity is a medication containing dulaglutide and is manufactured by Eli Lilly. It is approved for the treatment of adults with type 2 diabetes as an adjunct to diet and physical activity when blood sugar control is insufficient.

The treatment primarily aims to improve glycemic control. In clinical studies, some weight loss has also been observed, but the medication lacks a specific approved indication for the treatment of obesity. The effect on weight loss is generally more limited compared to newer incretin-based medications.

As a comparison, tirzepatide (Mounjaro), also from Eli Lilly, is a newer treatment that acts via both GLP-1 and GIP receptors. It is approved for the treatment of type 2 diabetes and also for chronic weight management. In clinical studies, tirzepatide has shown greater average weight loss compared to dulaglutide.

The choice of treatment is always based on an individual medical assessment, where treatment goals, comorbidities, and tolerability are weighed in.

How Trulicity is administered – solution in a pre-filled injection pen

Trulicity is administered once a week by injecting dulaglutide superficially into the subcutaneous fat on the stomach or thigh.

The injection pen is designed to allow for easy self-administration at home after instruction from a healthcare provider. The medication is delivered as a pre-measured dose in a pre-filled pen, which reduces the need for manual handling and contributes to safe and correct dosing.

The needle is short and thin, which means most people experience the prick as nearly painless. The medication should be given subcutaneously (under the skin). It is recommended to take the medication on the same day every week, as this can contribute to a steady drug effect and make it easier to remember the dose.

Trulicity is available in four doses: 0.75 mg, 1.5 mg, 3 mg, and 4.5 mg. The recommended starting dose for adults is 0.75 mg once a week, and if necessary, the dose can be increased to 1.5 mg once a week. If blood sugar control is still insufficient, the dose can be increased to 3 mg and finally to 4.5 mg once a week.

Interactions: How is the treatment affected by other medications?

Trulicity (dulaglutide) can delay gastric emptying, which in some cases can affect how quickly the body absorbs medications taken by mouth.

This effect usually has limited clinical significance but may be relevant for medications where rapid or precise absorption is important. When treating with such medications, an individual assessment may need to be made.

The risk of serious drug interactions is generally low. However, particular caution should be exercised during simultaneous treatment with other blood sugar-lowering medications.

When combined with insulin or sulfonylureas, the risk of hypoglycemia (low blood sugar) may increase. In these cases, it may be necessary to adjust the dose of the other diabetes treatment in consultation with the treating physician.

It is important to inform healthcare professionals about all medications you use, including over-the-counter drugs, herbal remedies, and supplements, to ensure safe treatment.

Who can get dulaglutide prescribed for weight loss?

Dulaglutide (Trulicity) is approved for the treatment of type 2 diabetes and has no approved indication for the treatment of obesity.

In some cases, a doctor may still consider treatment outside the approved indication (so-called off-label use), but this occurs after an individual medical assessment where benefit and risk are carefully weighed.

For patients seeking treatment solely for overweight or obesity, medications specifically approved for this purpose, such as semaglutide (Wegovy) or tirzepatide (Mounjaro), are primarily used.

Off-label use of dulaglutide may be considered in certain situations, for example, if other treatment options are not suitable or available. Such an assessment is based on the patient's overall health status, including BMI and the presence of weight-related diseases.

Common side effects and how to relieve them

The most common side effects of treatment with Trulicity are nausea, diarrhea, vomiting, and constipation. These most often appear at the start of treatment or in connection with a dose increase and are usually transient.

The gastrointestinal complaints are related to the medication's mechanism of action, partly because gastric emptying is delayed. This can contribute to a feeling of early satiety and sometimes nausea, especially with larger meals.

The discomfort can often be relieved through simple adjustments:

• Eat smaller portions and stop eating at early signals of fullness.
• Chew food thoroughly to aid digestion.
• Avoid very fatty or hard-to-digest foods.
• Drink enough fluids evenly throughout the day.

In case of persistent or severe side effects, you should contact healthcare professionals for assessment and possible dose adjustment.

The importance of muscle mass and protein during weight loss

To promote a healthy body composition during weight loss, it is important to combine the treatment with sufficient protein intake and regular strength training. The goal is to preserve muscle mass to the greatest extent possible while fat mass decreases.

Medication treatment can contribute to a reduced energy intake. During an energy deficit, the body uses both fat and muscle tissue as an energy source. Without sufficient protein intake and muscle-stimulating activity, part of the weight loss may therefore consist of the loss of muscle mass.

Since muscle mass contributes to the body's energy expenditure, a loss of muscle will lower the basal metabolic rate. This means your body burns fewer calories at rest, making it harder to keep the new weight stable in the long term. Strength training acts as a signal to the body to preserve musculature, while protein provides the building blocks required to maintain and repair muscle tissue.

Common questions about Trulicity

How does Trulicity work for weight loss?

Trulicity contains dulaglutide, which belongs to the group of GLP-1 receptor agonists. The medication mimics the effect of the body's own hormone GLP-1 and affects both blood sugar regulation and appetite.

The treatment can contribute to an increased feeling of fullness and reduced energy intake, partly by delaying gastric emptying and affecting appetite regulation. In some patients, this leads to some weight loss.

However, Trulicity is primarily approved for the treatment of type 2 diabetes and has no specific indication for the treatment of obesity. Use for weight loss may in some cases be considered by a doctor after an individual medical assessment.

Is it legal to buy Trulicity without a prescription?

Trulicity is a prescription medication within the EU and may only be prescribed by licensed healthcare professionals after a medical assessment.

Buying medication through unregulated or unauthorized websites involves significant risks. Products may be counterfeit, incorrectly dosed, or lack quality control, which can lead to serious health consequences.

Does the injection with the pen hurt?

Most patients experience the injection as slightly or not at all painful. The pre-filled pen uses a very thin and short needle, and the medication is injected superficially into the subcutaneous fat.

However, the experience can vary between individuals, and some may feel slight discomfort at the time of injection.

What do I do if I miss a dose?

If you miss a dose, you can take it as soon as you remember, provided there are at least 3 days (72 hours) left until the next scheduled dose.

If there are less than 3 days left, you should skip the missed dose and take the next dose on your regular day.

Do not take a double dose to compensate for a missed injection.

Sources

European Medicines Agency (EMA). Trulicity – Summary of Product Characteristics (SmPC). https://www.ema.europa.eu/en/medicines/human/EPAR/trulicity

Gerstein HC et al. Dulaglutide and cardiovascular outcomes in type 2 diabetes (REWIND). The Lancet. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)31149-3/abstract

Bonora, E., Frias, J.P., Tinahones, F.J. et al. (2021). Effect of dulaglutide 3.0 and 4.5 mg on weight in patients with type 2 diabetes: Exploratory analyses of AWARD-11. Diabetes, Obesity & Metabolism. https://doi.org/10.1111/dom.14465

Konstantinos C Koskinas, Emeline M Van Craenenbroeck, Charalambos Antoniades, Matthias Blüher, Thomas M Gorter, Henner Hanssen, Nikolaus Marx, Theresa A McDonagh, Geltrude Mingrone, Annika Rosengren, Eva B Prescott, the ESC Scientific Document Group , Obesity and cardiovascular disease: an ESC clinical consensus statement. European Heart Journal. https://doi.org/10.1093/eurheartj/ehae508

World Health Organization (WHO). (2020) WHO guidelines on physical activity and sedentary behaviour. Geneva: World Health Organization. https://www.who.int/publications/i/item/9789240015128