In four trials including a total of more than 3000 patients, dulaglutide reduced the HbA1c concentration as effectively as other GLP-1 analogues when added to other hypoglycaemic drugs.The long elimination half-life of dulaglutide can make management of adverse effects and drug interactions more difficult. More data are needed on possible cardiac adverse effects. Metformin appears to reduce mortality and prevent certain complications in patients with type 2 diabetes. When metformin is unsuitable, the choice of treatment depends on the glycated haemoglobin (HbA1c) target. Options include: settling for a higher HbA1c target; using a "second-generation" sulph-onylurea such as glibenclamide; or using insulin if a significant decline in the HbA1c is desirable (1). If weight gain or hypoglycaemia is a major concern, one alternative is to replace insulin by exenatide, an analogue of GLP-1 (glucagon-like peptide 1), a hormone belonging to the incretin family (1,2). Dulaglutide (Trulicity0, Eli Lilly), anoth-er-GLP-1 analogue, has now been approved in the EU for weekly subcutaneous injection, like exenatide. The plasma concentration of dulaglutide reaches a plateau after 5 days, and its elimination half-life is about 5 days (3). Its sustained action is due to the presence of a double polypeptide chain linked to an antibody fragment, which slows its passage into the bloodstream and, thus, its degradation and renal clearance (3,4). How effective are weekly dulaglutide injections compared with other GLP-1 analogues or insulin? Does weekly dulaglutide administration have any specific adverse effects, in particular due to its long half-life?
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