Black Health
GLP-1 receptor agonist Type 2 diabetes Cardiovascular risk reduction in T2D

Dulaglutide (Trulicity) and Black patients

Brand names: Trulicity

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What Dulaglutide does

Dulaglutide is a once-weekly injectable GLP-1 receptor agonist indicated for type 2 diabetes and for reducing major adverse cardiovascular events in adults with T2D at cardiovascular risk. It is administered via a single-use pen.

What the evidence says for Black patients

The REWIND trial (Gerstein et al., Lancet 2019;394:121–30, PMID 31189511) enrolled 9,901 T2D patients and showed a 12 percent relative reduction in MACE. Unusual for its size, REWIND enrolled a primary-prevention majority (69 percent without prior CV events), strengthening applicability to many middle-aged Black adults with diabetes but no prior MI or stroke. Race subgroup analyses showed consistent treatment effects.

AWARD-11 compared 1.5, 3, and 4.5 mg doses and showed improved A1C and weight loss with higher doses without a commensurate rise in GI symptoms (Frias et al., Diabetes Care 2021;44:765–73, PMID 33573963).

As with other GLP-1s, Black adults are under-prescribed dulaglutide relative to clinical need. Cost and insurance PA remain dominant barriers.

Common alternatives

Semaglutide (Ozempic) and tirzepatide (Mounjaro) are both weekly-injection alternatives with larger A1C and weight effects. Liraglutide (Victoza) is a daily alternative. For patients who cannot afford GLP-1s, metformin plus an SGLT2 inhibitor is a reasonable evidence-based substitute.

Side effects

  • Nausea, vomiting, diarrhea
  • Injection-site reactions
  • Pancreatitis (rare)
  • Gallbladder disease
  • Boxed warning — medullary thyroid carcinoma (rodent signal); MEN2 contraindicated

Factors that affect adherence

Some patients find the Trulicity pen easier than Ozempic's at initial training; consider pen familiarity when choosing between GLP-1s. Generic dulaglutide is not expected until patent expiry in 2027. Manufacturer savings programs can reduce commercial-insurance copays substantially.

Questions to ask your doctor

Bring this list to your next appointment.

  • If I have diabetes plus CV risk factors (but no prior event), is dulaglutide right for me given REWIND's primary-prevention data?
  • Which GLP-1 pen will be easiest for me?
  • Will my insurance cover this?

References

  1. Gerstein HC, Colhoun HM, Dagenais GR, et al. Dulaglutide and cardiovascular outcomes in type 2 diabetes (REWIND). Lancet. 2019;394:121–130. PMID 31189511.
  2. Frias JP, Bonora E, Nevarez Ruiz L, et al. Efficacy and safety of dulaglutide 3.0 and 4.5 mg in patients inadequately controlled with dulaglutide 1.5 mg (AWARD-11). Diabetes Care. 2021;44:765–773. PMID 33573963.
  3. U.S. Food and Drug Administration. Trulicity (dulaglutide) label. https://www.accessdata.fda.gov/drugsatfda_docs/label/2014/125469s000lbl.pdf

Medical disclaimer

This page is patient education, not prescribing guidance. It summarizes the published evidence about how this medication has been studied in Black patients — it is not a substitute for the judgment of your personal clinician. Never start, stop, or change a prescription based on something you read here. If you have questions about your medication, call your prescriber or pharmacist. For emergencies, call 911.

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