A guide on using Dulaglutide for T2D

In this episode, we provide a practical guide to using Dulaglutide (Trulicity) for managing Type 2 Diabetes (T2D). We start with the importance of lifestyle interventions and weight reduction, then explore the role of pharmacological management and the science behind GLP-1 receptor agonists.

Topics

Lifestyle interventions and weight reduction
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how do we best approach pharmacological management?
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GLP-1 receptor agonists. How do these medication work exactly?
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advantages of these medications in the diabetic patient.
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What cohort will benefit from these medications?
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benefits beyond diabetes
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When should we be cautious about prescribing these medications?
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Do we have to worry about hypoglycemia?
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How do these new medications fit in our prescribing pathway for diabetes?
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What GLP-1 receptor agonists are currently available in NZ?
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Why would we choose Trulicity over another GLP-1 receptor agonist?
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Who is it funded for?
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Dosing titration and monitoring
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What are the common side effects?
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Weigth loss
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Take-home messages
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Take home messages

Assess all people with T2D for CKD with UACR and sCR, and consider prescribing SGLT2i (Jardiance is funded under SA) for long term renal benefit, along with ACEi/ARB, and other BP lowering meds as needed.
Assess all people with T2D for CVD risk or past IHD, and consider prescribing GLP1RA (along with statins, BP lowering, smoking cessation)
If not suitable or eligible for funding for SGLT2i then consider prescribing GLP1RA or vice versa.
Stop vildagliptin (Galvus) when using GLP1RA. Trulicity 1.5mg SC weekly is funded under SA.
May use both Jardiance and Trulicity but only one can be reimbursed through SA funding.

Resources

Best Practice e-Journal - Diabetes Special Edition bpacnz (2021)
Trulicity (dulaglutide 1.5 mg/0.5 mL) solution for injection NZ Data Sheet (2021)
Dulaglutide and cardiovascular outcomes in type 2 diabetes (REWIND): a double-blind, randomised placebo-controlled trial. Lancet (2019)
Type 2 Diabetes Management Guidance. NZSSD and MOH (2021)
Decision to fund two new medicines for type 2 diabetes - Amended with Q&A PHARMAC (2021)

Patient Resources

Presenter

Rinki Murphy

Diabetes Physician

Rinki is an Associate Professor in Medicine at the University of Auckland and Principle investigator at the Maurice Wilkins Centre for Biodiscovery. She is a diabetologist at Auckland and Counties Manukau DHBs.