Dulaglutide (Trulicity): what it is, how it works, results and side effects

What is dulaglutide?

Dulaglutide is a medicine for type 2 diabetes. It belongs to a group called GLP-1 receptor agonists, the same group as semaglutide and liraglutide. Eli Lilly sells it as Trulicity, and it was first approved in the US in 2014.¹

Before going further, it helps to know the difference between a medicine and a brand.

Paracetamol is the medicine. Tylenol, Panadol, Crocin and Calpol are brands of it. In the same way, dulaglutide is the medicine and Trulicity is the brand. Brand names can differ from country to country.

Dulaglutide is made in living cells, not mixed from chemicals.¹ Copies of this kind of medicine are called biosimilars rather than generics. In August 2025, China approved the first biosimilar of Trulicity, made by Boan Biotech.¹⁶

Dulaglutide and its brands

Names only, not a recommendation. Not every brand or dose is sold in every country.

How does it work in your body?

Your gut makes a hormone called GLP-1 (glucagon-like peptide-1) after you eat. Dulaglutide copies it, but stays in your body for days instead of minutes.²

Your own GLP-1 is broken down by an enzyme (a protein that breaks other things down) within 1.5 to 2 minutes. Dulaglutide is a GLP-1 piece joined to part of an antibody, a large protein. That makes it resist the enzyme, enter the blood slowly and leave through the kidneys slowly.^1,2

The insulin effect switches on only when sugar is high. Taken on its own or with metformin, mild low-sugar episodes affected about 6 to 11 in 100 people in trials, and none were severe. The risk goes up when it's taken with insulin or a sulfonylurea, a group of sugar pills that includes glimepiride and gliclazide.^1,2

How it compares with the other GLP-1 medicines: semaglutide, tirzepatide and liraglutide.

Who is it for?

Dulaglutide is approved for type 2 diabetes. It is not approved as a weight-loss medicine. Whether it suits you is a decision for you and your doctor.

• Adults with type 2 diabetes, alongside diet and exercise.^1,2 In the EU it is used on its own only when metformin, the usual first diabetes pill, doesn't suit someone. Otherwise it's added to other diabetes medicines.²
• Children aged 10 and over with type 2 diabetes, at doses up to 1.5 mg.^1,2
• Adults with type 2 diabetes and heart disease, or several heart risk factors. The US label adds lowering the risk of heart attack, stroke and heart death.¹ More below.

Not for type 1 diabetes. The EU label says it should not be used for type 1 diabetes and is not a substitute for insulin.² (A label is the official document that says what a medicine is approved for and how to use it.)

What about weight loss?

Neither the US nor the EU label lists weight loss as an approved use.^1,2 Using a medicine for something its label doesn't cover is called off-label use. The rules differ by country. In the US, the FDA says doctors generally may prescribe an approved medicine for an unapproved use when they judge it medically right for their patient.¹²

The medicines approved for weight are other brands, such as Wegovy (semaglutide). In the EU, Wegovy's label covers adults with a BMI of 30 or more, or 27 or more with a weight-related condition such as high blood pressure or prediabetes.¹³ BMI (body mass index) is your weight in kilograms divided by your height in metres, squared. Check your BMI.

Many Asian guidelines use lower cut-offs. In India, for example, obesity starts at a BMI of 25.¹⁴ The India guide to your options explains them.

How do you take it?

One injection under the skin once a week, on the same day, at any time of day, with or without food. You start low and go up in steps.¹

• Where: the stomach area, thigh or upper arm. Use a different spot each week.¹
• The pen: each pen holds one dose. The liquid should be clear and colourless.¹
• With insulin: give them as two separate injections. Never mix them.¹

Why once a week, and how long it stays in your body

Half of each dose is still in your blood after about 5 days. That's why one injection a week is enough. Levels build up and settle after 2 to 4 weeks of weekly doses.¹

The same slow clearing means the medicine doesn't vanish the day you stop. This matters for planning a pregnancy, which is covered in who shouldn't take it.

What did the trials find?

Dulaglutide lowered blood sugar in every main trial. Weight loss was modest: about 3 kg on the 1.5 mg dose and up to about 5 kg on 4.5 mg, on average.^1,5

Several of Eli Lilly's dulaglutide trials are named AWARD, and Lilly paid for the ones on this page.^5,7,8 Many of these trials worked like this:

• People were split into groups at random. One group got dulaglutide. Another got a dummy injection (placebo) with no medicine in it, or a different medicine.
• Everyone kept the same diet and exercise advice, and often nobody knew who was on what.
• So the gap between the groups is what the medicine itself added.³

HbA1c is a blood test that shows your average blood sugar over the past few months. A fall of 1 point means, for example, going from 8% to 7%.

Blood sugar

Change in HbA1c after 26 weeks, in points

In AWARD-11, which tested the higher doses in 1,842 adults over 36 weeks, HbA1c started at 8.6%. It fell by 1.5 points on 1.5 mg, 1.6 on 3 mg and 1.8 on 4.5 mg. That trial had no dummy-injection group.^1,5 About 62 in 100 people on 4.5 mg reached an HbA1c under 7%, against 50 in 100 on 1.5 mg.¹

Weight

Average weight lost. Percent is of starting body weight. "At 90 kg" is for someone who starts at 90 kg (198 lb).

How many lost a meaningful amount? In AWARD-11, 49 in 100 people on 4.5 mg lost at least 5% of their body weight, as did 40 in 100 on 3 mg and 31 in 100 on 1.5 mg.² Put the other way, about half of those on the top dose lost less than 5%.

These are averages. Across the label's trials, weight change on 1.5 mg ranged from a loss of 0.35 kg to a loss of 2.9 kg, and on 0.75 mg from a gain of 0.86 kg to a loss of 2.6 kg.² People lost weight whether or not they felt sick, though a little more in those who did.²

Compared head to head with other medicines

You can't compare cards from different trials, because the people and doses differ. Head-to-head trials put two medicines in the same group of people.

• Against liraglutide (AWARD-6): 599 adults on metformin, 26 weeks. Weekly dulaglutide 1.5 mg lowered HbA1c by 1.42 points and daily liraglutide 1.8 mg by 1.36, about the same. Nausea affected 20 in 100 on dulaglutide and 18 in 100 on liraglutide. Lilly paid for it.⁷
• Against metformin: in a 26-week trial of 807 adults, HbA1c fell by 0.8 points on dulaglutide 1.5 mg and 0.6 on metformin. Weight fell by 2.3 kg and 2.2 kg.¹
• Against tirzepatide for heart outcomes: see SURPASS-CVOT below.

SUSTAIN 7 didn't test dulaglutide 3 mg or 4.5 mg, so it doesn't tell us how those higher doses compare.⁶

Children and teenagers

In AWARD-PEDS, 154 young people aged 10 to 17 with type 2 diabetes took part for 26 weeks. HbA1c fell by 0.9 points on 1.5 mg and rose by 0.6 points on a dummy injection. BMI didn't change differently between the groups.⁸

Does it protect the heart and kidneys?

In one large trial, REWIND, dulaglutide lowered the combined risk of heart attack, stroke and heart death a little, compared with a dummy injection.³

• Strokes: 27 in 1,000 had a non-fatal stroke on dulaglutide, against 35 in 1,000 on the dummy injection. The label says these single parts weren't tested for proof on their own.¹
• Deaths from any cause: 108 in 1,000, against 120 in 1,000. The trial couldn't show this gap was real rather than chance.³
• Kidneys: in a later, exploratory look at REWIND, 171 in 1,000 had a kidney problem on dulaglutide, against 196 in 1,000. Most of the difference was fewer new cases of large amounts of protein in the urine, an early sign of kidney damage.⁴ "Exploratory" means the trial wasn't designed to answer this, so treat it as a hint.

Against tirzepatide (SURPASS-CVOT). This trial gave 13,299 adults with type 2 diabetes and heart disease either tirzepatide or dulaglutide 1.5 mg. Heart attack, stroke or heart death happened in 122 in 1,000 on tirzepatide and 131 in 1,000 on dulaglutide. Tirzepatide was shown to be no worse, but not shown to be better. Eli Lilly, which makes Trulicity, paid for it.^1,9

What are the common side effects?

Stomach and gut effects. In the US label's dummy-controlled trials, 41 in 100 people on 1.5 mg had at least one, against 21 in 100 on a dummy injection.¹

The most common are feeling sick, diarrhoea, vomiting and stomach pain.¹ The EU label says these were mostly mild or moderate and didn't last.² At 1.5 mg, about half of stomach effects were rated mild, 4 in 10 moderate and about 1 in 10 severe.¹

Out of every 100 people, how many felt sick (nausea):

Stomach side effects made 35 in 1,000 people on 1.5 mg stop, against 2 in 1,000 on the dummy injection.¹

Side effects at a glance

Out of every 100 people in the US label's pooled dummy-controlled trials, how many had each one.¹ The word in brackets is how often the EU label says it happens.²

Rounded to whole numbers. Dummy-injection figures are the same group in both rows of a card. Other less common effects on the labels: wind, bloating, heartburn, burping, a change in taste, and a faster heartbeat (up 2 to 4 beats a minute on average).^1,2

Serious risks, and who shouldn't take it

Serious problems are uncommon or rare, but you should know the warning signs.

The frequency words come from the EU Trulicity label: uncommon means 1 in 100 to 1 in 1,000 people, and rare means 1 in 1,000 to 1 in 10,000.² "Per 1,000 patient-years" means cases if 1,000 people took the medicine for a year.

Who shouldn't take it, or needs to check first

• A serious allergy to dulaglutideBoth labels.^1,2
  Past pancreatitisIf pancreatitis is confirmed on dulaglutide, the EU label says don't restart.²
• Medullary thyroid cancer or MEN 2Yourself or a family member (US label).¹
  Severe gastroparesisA stomach that empties very slowly. Not recommended.^1,2
• Type 1 diabetesNot to be used, and not a substitute for insulin (EU label).²
  Kidney failureNo dose change is needed for weaker kidneys, but the EU label can't recommend it in end-stage kidney disease.^1,2
• BreastfeedingThe EU label says it should not be used.²
  Pregnant or planning a pregnancyEU: not recommended in pregnancy. US: only if the benefit justifies the risk. Neither label sets a gap before trying for a baby, so plan it with your doctor.^1,2

What happens if you stop?

It leaves your body gradually: half of a dose is still there after about 5 days.¹ Blood sugar is likely to rise unless another treatment takes its place. Don't stop without talking to your doctor.

We found no trial that looked at what happens when people stop dulaglutide in particular. A 2025 review pooled 4 small trials of older GLP-1 medicines (liraglutide and exenatide) in 219 people with type 2 diabetes. After stopping, HbA1c rose by about 0.65 points on average, though results varied a lot between trials.¹¹

If side effects are the reason you want to stop, tell your doctor. The slow dose steps exist to lower the risk of stomach side effects.¹ The India guide to stopping covers stopping GLP-1 medicines in more depth.

Day to day: missed doses, storage, food and exercise

If you miss a dose

• 3 days (72 hours) or more until your next dose: take the missed dose as soon as you can.¹
• Less than 3 days to go: skip it and take the next dose on your usual day.¹
• Changing your injection day: fine, as long as your last dose was at least 3 days before the new day.¹

Neither label gives a restart plan after several missed weeks.^1,2 Ask your doctor which dose to restart on.

Storing the pens

• Keep them in the fridge, at 2–8 °C (36–46 °F), in the box to protect them from light.¹
• Out of the fridge: each pen can be kept at room temperature, not above 30 °C (86 °F), for up to 14 days in total.¹
• Never freeze it, and don't use a pen that has been frozen.¹

Other medicines

Because it slows the stomach, dulaglutide can change how fast some tablets are absorbed. The US label advises checking blood levels of medicines like warfarin, a blood thinner.¹ The EU label found no meaningful effect on the contraceptive pill, and no change of pill is needed.² Because it's a medicine made in living cells, the EU label asks that the brand and batch number are recorded, so keep the box details.²

Food, protein and exercise

When people lose weight, some of it is muscle. A smaller appetite can also make it harder to eat enough protein. A 2025 joint advisory from four US obesity and nutrition societies, on eating well while taking GLP-1 medicines, suggests the targets below.¹⁰

If you have kidney disease, ask your doctor before eating more protein.

In your country

Brands, doses on sale, prices and who can prescribe differ by country. We're adding country guides one at a time.

Questions people ask