Who can take Trulicity for weight loss?
So, how did GLP-1 receptor agonists come to be indicated for weight loss? The answer is that not all of them are. To better understand why that is, you have to understand the Food and Drug Administration (FDA) approval process for an indication. While weight loss has been noted with more than one GLP-1 receptor agonist, not every manufacturer has put their GLP-1 receptor agonist through the approval process for a secondary indication of weight loss. Novo Nordisk is the manufacturer of Ozempic (semaglutide), a GLP-1 that was approved in 2017 for the treatment of Type 2 diabetes. During its study, the manufacturer noted weight loss of 15%-18%, more than many other drugs approved for weight loss. So Novo Nordisk began testing it at higher doses in patients who didn’t have Type 2 diabetes. In 2021, Novo Nordisk released semaglutide under the trade name Wegovy approved for weight loss in patients who meet certain body mass index (BMI) criteria.
Not every GLP-1 receptor agonist has sought approval from the FDA to list weight loss as an indication. In spite of this, many healthcare professionals will prescribe them for weight loss, making this type of use “off-label.” Off-label use refers to utilizing a drug for a purpose that is not approved by the FDA. Trulicity is officially approved for the treatment of Type 2 diabetes in combination with diet and exercise and for the reduction of cardiovascular mortality. The big question is—is there any evidence that Trulicity is effective for weight loss?
Does Trulicity cause weight loss?
Weight loss may be observed in patients who take Trulicity. Lilly USA, the makers of Trulicity, reported the results of a 36-week observation of patients with a BMI of greater than or less than 33.2 or higher. Doses of Trulicity 1.5 mg, 3.0 mg, and 4.5 mg were evaluated. Patients with higher BMI taking higher doses of Trulicity experienced the most weight loss as measured in pounds lost from baseline. The average weight loss from the highest Trulicity dose of 4.5 mg was 10.1 pounds.
The results of the AWARD-11 trial concur that weight loss occurs most frequently in patients with the highest starting BMI on the highest doses of Trulicity. While most patients do lose some weight, there is a chance they will not lose weight, or may even gain weight.
How does Trulicity work for weight loss?
Trulicity and other GLP-1 receptor agonists were designed to mimic the structure of naturally occurring hormones in the human body known as incretin hormones. When you eat food, your stomach releases these hormones, and they, in turn, stimulate the release of insulin from the pancreas. Insulin helps control blood sugar levels by helping cells absorb glucose to be used for energy. Type 2 diabetes patients often lack enough incretin hormones to stimulate this process, and that is why the GLP-1 receptor agonists are effective at helping them manage their blood sugar.
So how does this mechanism help with weight loss? Incretin hormones, along with the chemically similar GLP-1 receptor agonists, slow gut motility and therefore slow the emptying of the gastrointestinal tract. This leads to food remaining in the intestinal tract longer and therefore increased and prolonged feelings of satiety, or feeling full. The feeling of being full leads to appetite suppression, which is thought to be the primary way GLP-1 receptor agonists like Trulicity aid with weight loss.
Who can take Trulicity for weight loss?
While there are some GLP-1 receptor antagonists that are approved by the FDA for weight loss, Trulicity is not. Saxenda (liraglutide), Ozempic (semaglutide), and Wegovy (semaglutide tablets) do have approval to be used in weight loss. Trulicity has been used off-label for weight loss, and some studies have supported that Trulicity can cause weight loss in some patients. AWARD-11 was a randomized, controlled trial that evaluated the efficacy and safety of Trulicity at multiple doses. This trial was all Type 2 diabetes patients. Patient results were divided by BMI and Trulicity dose. In the reporting, patients with the highest BMIs (the most overweight) taking the highest dose of Trulicity (4.5 mg) experienced the most weight loss.
Trulicity is only approved to be used in Type 2 diabetes mellitus patients. Many Type 2 diabetes patients also suffer from obesity. If you are not diabetic and take Trulicity, there could be serious side effects and adverse events related to hypoglycemia, or low blood glucose levels. It can make you shaky, lower your blood pressure too much, or even make you unconscious. If you are diabetic and taking Trulicity, you may experience weight loss, and that is ok as long as your physician is monitoring the appropriate parameters. Giving Trulicity only for the purpose of weight loss, especially in a non-diabetic, should not be done.
Trulicity dosage for weight loss
|Dosage||Average weight loss|
|1.5 mg||6.6 lbs|
|3 mg||8.4 lbs|
|4.5 mg||10.1 lbs|
There are some considerations before your doctor can decide if Trulicity treatment is appropriate for you. If you have ever had an allergic reaction to Trulicity, you should not repeat the treatment. If you have a history of thyroid cancer (specifically medullary thyroid carcinoma) or multiple endocrine neoplasia, the use of Trulicity is contraindicated as well. Severe abdominal pain when taking Trulicity should be evaluated as it could be linked to pancreatitis. Trulicity has been linked to dangerously low blood sugar levels, though this is rare. More common side effects of Trulicity include nausea and diarrhea.
Other diabetic medications that cause weight loss
Trulicity is not an approved weight loss drug. Type 2 diabetes mellitus patients who take Trulicity to lower their blood sugar may also benefit from some weight loss while taking Trulicity. Patients who are not diabetic should not take Trulicity.
Other GLP-1 receptor agonists have been shown to cause weight loss as well. Ozempic (semaglutide) is approved with an indication for weight loss. The SUSTAIN 7 clinical trial compared Trulicity and Ozempic head to head in Type 2 diabetes patients on Metformin alone. The results showed as much as twice the weight loss with Ozempic as compared to Trulicity. This trend held at multiple dosing intervals compared.
Victoza (liraglutide) was compared to Trulicity in the AWARD 6 trial. This study found that the weight loss associated with Victoza was significantly better than that associated with Trulicity. We would expect this because Saxenda, another branded product of liraglutide, is marketed and approved for weight loss.
Metformin, a prescription diabetes drug in the sulfonylureas class, is typically a first-line treatment for Type 2 diabetics and has also been linked to weight loss, though it is not approved for it. The AWARD 3 trial showed similar rates of weight loss between Trulicity and metformin treated patients. Metformin is generic and very cost effective. It is also an oral medication, whereas GLP-1 receptor agonists are almost all injectable drugs.
You should not use any of these drugs for weight loss without the medical advice of your physician.
How to maximize Trulicity benefits
Trulicity is a once-weekly diabetes medication also approved to lower cardiovascular risk. It should not be given more often than every seven days. It can be given at any time of the day without regard to meals. Do not mix Trulicity with other drugs such as insulin. Each pen is labeled with the dose and is for single use only. Trulicity should be stored in the refrigerator, but it can be removed for a short period of time prior to the injection to allow it to come to room temperature and be a less painful injection.
Trulicity does not interact with grapefruit or grapefruit juice. It is also safe to consume caffeine in normal amounts. While alcohol is not contraindicated with Trulicity, it can increase the likelihood of stomach upset, diarrhea, or vomiting. Alcohol should be consumed responsibly and in limited amounts.
WHAT IS TRULICITY® (DULAGLUTIDE)?
Trulicity® is the brand name for dulaglutide, a glucagon-like peptide-1 agonist (or GLP-1) medication. It is a once-weekly injectable medication and one of several GLP-1 medications prescribed by Calibrate doctors as a part of our Metabolic Reset program.
Trulicity® is manufactured by Eli-Lilly and Company, an American pharmaceutical company. Eli-Lilly also recently gained FDA approval for another, similar drug: The first dual GLP-1/GIP receptor agonist, Mounjaro™ (tirzepatide).
Trulicity® was FDA-approved in 2014 as a treatment for adults with type 2 diabetes to be used in conjunction with lifestyle changes (i.e. food and exercise).
Across six unique clinical trials that included a total of 3,342 patients, treatment with dulaglutide “resulted in greater reductions from baseline in HbA1c levels compared with placebo.”
Researchers declared Trulicity® an attractive option for patients thanks to its convenient, once-weekly dosing schedule and its efficacy in lowering blood sugar levels.
HOW DOES TRULICITY® (DULAGLUTIDE) WORK?
Trulicity®, like other GLP-1 drugs, works by mimicking the natural incretin hormones that your body produces.
Incretin hormones signal to the brain, endocrine, and gastrointestinal systems that food has been consumed. This results in a complex cascade of hormones and neurotransmitters which effectively communicate feelings of satiety (feeling full) and slow down the rate at which food leaves your stomach (making you feel fuller for longer).
In addition, GLP-1 medications can improve blood sugar levels in people living with impaired glucose tolerance or diabetes. As explained by the manufacturer, Trulicity® “helps your pancreas release insulin in response to high levels of sugar in your blood after you eat” and “can limit how much sugar gets into your blood from your liver.”
If you’re worried about hypoglycemia (low blood sugar), rest assured that GLP-1 medications pose a relatively small risk. Hypoglycemia is typically only a concern when GLP-1s are used in conjunction with other diabetes medications such as insulin.
As one 2015 study evaluating Trulicity® concluded, “The long-acting GLP-1 receptor agonists improve glycemic control and help to promote weight loss. Furthermore, based on their glucose-dependent mechanism of action, the GLP-1 receptor agonists have a low risk for hypoglycemia.”
Why Calibrate? Can’t I just take the medication?
As is the case with all GLP-1s, Trulicity® makes it easier to lose weight and stick to healthy habits—but it doesn’t produce weight loss on its own. It must be used in combination with habits to support metabolic health and avoid weight regain. These tactics may include modifications to what you eat, how and when you exercise, and other healthy lifestyle changes.
Calibrate’s Metabolic Reset combines GLP-1 medication with evidence-based lifestyle recommendations to help participants maximize their success with Trulicity®. They’re called the Four Pillars of Metabolic Health, and they include: Food, Sleep, Exercise, Emotional Health.
Throughout your Calibrate program, you’ll work your way through a curriculum developed by a world-class medical advisory board that teaches you how to integrate healthy changes into your day-to-day routine, taking a science-based approach to weight loss. You’ll learn how to eat more whole foods and fewer fast-digesting carbohydrates, improve sleep quality, participate in at least 150 minutes of physical activity per week, and develop strategies for managing stressors.
Through the Calibrate curriculum, both your mind and body will be set up for sustainable progress—allowing Trulicity® (or any other GLP-1 drug you might be prescribed) to work even more effectively.