Dulaglutide (Trulicity) – Mechanism of Action, Cost, and Comparison with Semaglutide
Drugs from the GLP-1 receptor agonist class provide benefits in glycemic control while also contributing to weight reduction, cardiovascular risk reduction, and improved metabolic outcomes. Dulaglutide and semaglutide are often directly compared. LuMedic has prepared this article to explain how dulaglutide works, its cost, reimbursement status, and how it compares with semaglutide.
What is Dulaglutide?
Dulaglutide is a GLP-1 receptor agonist approved for the treatment of type 2 diabetes. Its brand name is Trulicity. It can be used in adults with type 2 diabetes either as monotherapy or in combination with other antidiabetic agents.
In periods of semaglutide shortage, dulaglutide has also been prescribed off-label for obesity management. Off-label means the drug is not officially registered for that specific condition in the country, but if scientific evidence supports its efficacy, such use may be implemented under certain conditions.
Mechanism of Action of Dulaglutide
To understand dulaglutide’s action, it is important to know it is a GLP-1 analogue. GLP-1 is a hormone secreted by the small intestine (one of the incretin hormones). Its levels rise after a meal, stimulating insulin secretion in a glucose-dependent manner. At the same time, it inhibits glucagon release, delays gastric emptying, prolongs satiety, and reduces appetite.
Indications
- Type 2 diabetes mellitus in monotherapy or in combination with other antidiabetic drugs,
- In adults and children ≥10 years of age with inadequately controlled glycemia,
- Always as an adjunct to diet and physical activity.
Dulaglutide in Pregnancy and Lactation
The use of dulaglutide during pregnancy is not recommended. Studies suggest a potential risk of adverse fetal effects, while clinical data in pregnant women are very limited.It should not be used during pregnancy or breastfeeding, since it is unknown whether it is excreted in breast milk
Dulaglutide Dosage
Route of administration: subcutaneous injection into the abdominal wall, thigh, or upper arm, at any time of day, with or without food.
Adults:
- Initial dose: 0.75 mg once weekly,
- If tolerated, may be increased to 1.5 mg once weekly,
- Higher doses: 3 mg or 4.5 mg once weekly if glycemic control remains insufficient.
Dose adjustments:
- Day of injection may be changed if at least 72 hours have passed since the last dose,
- Missed dose:
- If <3 days remain until the next scheduled dose → administer immediately,
- If >3 days remain → skip the missed dose.
Children ≥10 years:
- Start with 0.75 mg once weekly,
If glycemic control is unsatisfactory after at least 4 weeks, the dose may be increased to 1.5 mg once weekly.
Dulaglutide – Price and Availability in Poland
What determines the cost?
- Pharmacy pricing (margins, promotions, availability),
- Reimbursement status and patient eligibility.
Average price:
- A package of 2 pre-filled pens costs around 200 PLN, lasting 2 weeks.
- The monthly cost of therapy is therefore about 400 PLN.
- With reimbursement (patient co-payment 30%), the cost per package is approx. 60 PLN,
Monthly cost with reimbursement: about 120 PLN.
Is Dulaglutide Reimbursed?
Yes – dulaglutide is reimbursed in Poland (as of 2025) under specific criteria:
- Type 2 diabetes with HbA1c ≥7.5%,
- Patient treated with at least two other antidiabetic medications,
- Obesity with BMI ≥30 kg/m²,
- Very high cardiovascular risk, defined as:
- Confirmed cardiovascular disease, OR
- Target organ damage (proteinuria, left ventricular hypertrophy, or retinopathy), OR
- Presence of two or more major risk factors:
- Age ≥55 years (men) or ≥60 years (women),
- Dyslipidemia,
- Hypertension,
Smoking.
Where to buy?
Dulaglutide is available in both retail and online pharmacies but requires a prescription issued by a physician.
Dulaglutide vs. Semaglutide – Similarities and Differences
Similarities (shared GLP-1 receptor agonist mechanisms):
- Stimulate insulin secretion in response to elevated blood glucose,
- Suppress glucagon release,
- Delay gastric emptying,
- Reduce appetite → contributing to weight loss in some patients.
Key differences:
- Semaglutide is available in both injectable (weekly) and oral tablet form, whereas dulaglutide is only injectable.
- Semaglutide generally demonstrates greater potential for HbA1c reduction and weight loss.
Both drugs share similar adverse effects (nausea, vomiting, gastrointestinal discomfort), though tolerance varies by patient and dosage.
Summary – Responsible Use Matters
Dulaglutide is a weekly GLP-1 receptor agonist for type 2 diabetes, offering strong benefits in lowering blood glucose, reducing weight, and lowering cardiovascular risk.
When comparing dulaglutide with semaglutide, the latter often shows superior outcomes in HbA1c and weight reduction, as well as greater flexibility due to the availability of an oral form. Nevertheless, the decision of which drug to prescribe should be a joint decision between physician and patient, considering individual characteristics, risks, costs, preferences, and drug availability.
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