GLP-1 receptor agonists are a class of drugs that are used to treat type 2 diabetes mellitus. Glucagon-like peptide-1 receptor agonists have benefits extending outside blood sugar control, including positive effects on blood pressure, weight, beta-cell function, and cholesterol levels.
These drugs affect glucose control through several mechanisms, including slowed gastric emptying, enhancement of glucose-dependent insulin secretion, and reduction of postprandial glucagon and of food intake. They work by mimicking the effects of the incretin hormone GLP-1, that is released from the intestine in response to food intake.
Note – GLP-1 receptor agonists don’t cause hypoglycemia (low blood glucose). However, they can cause vomiting, diarrhea, nausea, weakness, headache, or dizziness.
GLP-1 receptor agonists are injected into the abdomen, upper arm, or thigh either once a day, twice a day, or once a week.
Here is a comparison between Trulicity and Bydureon, two GLP-1 receptor agonists:
Trulicity (dulaglutide) is a once-weekly subcutaneously administered GLP-1 receptor agonist. In 2014, it was approved by the US Food and Drug Administration as an adjunct to exercise and diet to improve glycemic control in people with type 2 diabetes.
It is manufactured by Eli Lilly and Company.
Bydureon is an injectable medicine that is used to improve blood sugar control in patients with type 2 diabetes mellitus.
Bydureon (exenatide) is the same drug as Byetta, with the exception that Bydureon is slower released needing one injection every seven days.
Mechanism of Action
Trulicity works by attaching to receptors of glucagon-like peptide 1 (GLP-1), that are found on the surface of the cells in the pancreas, and stimulating the receptor to release insulin.
Bydureon acts in the same way as incretins by increasing the amount of insulin released by the pancreas in response to food.
Possible side effects of Trulicity include:
- feeling jittery;
- fast heart rate;
- feeling tired or short of breath;
- loss of appetite;
- severe pain in your upper stomach;
- swelling in your feet or ankles;
- a hoarse voice;
- painful or difficult urination;
- trouble swallowing;
- little or no urinating;
- swelling or a lump in your neck;
Possible side effects of Bydureon include:
- reduced appetite;
- severe swelling of the lips, face, or tongue;
- itching at the injection site;
- weight loss;
- reduced kidney function;
- hair loss;
- feeling weak;
- skin rash;
- acid reflux;
- excess gas in the stomach and intestines;
- inflammation of the pancreas;
- unusual taste in the mouth;
- increased sweating;
- abdominal pain or bloating.
There are 2 dosages available for Trulicity: .75 milligrams and 1.5 milligrams. The initial dose is 0.75 mg subcutaneously once a week. The maximum recommended dosage is 1.5 mg subcutaneously once a week. This drug should be injected on the same day of each week.
The recommended dose of Bydureon is 2 mg subcutaneously once every week (on the same day each week) in the back of the upper arm, abdomen (belly), or thigh. These injections must not be injected into a muscle or a vein.
To make sure this GLP-1 receptor agonist is safe for you, tell your healthcare professional if you have:
- kidney disease;
- a history of pancreatitis;
- liver disease;
- if you have been sick with diarrhea or vomiting;
- if you also use insulin or oral diabetes drugs;
- slow digestion;
- gastroesophageal reflux disease (GERD);
- a stomach or intestinal disorder.
The use of this GLP-1 receptor agonist is not recommended in patients less than 18 years of age. Also, it is not for the treatment of diabetic ketoacidosis or type 1 diabetes mellitus.
Do not use this GLP-1 receptor agonist if:
- you are on dialysis;
- you have severe kidney problems;
- you are allergic to any of the ingredients in the medication;
- you have diabetic ketoacidosis;
- you have type 1 diabetes.
Moreover, this GLP-1 receptor agonist is not recommended for children and adolescents under 18 years of age.
Trulicity may interact in a negative way with the following medications:
- glimepiride (a sulfonylurea antidiabetic drug);
- Levemir (insulin detemir);
- Lantus (insulin glargine);
- Januvia (sitagliptin).
Bydureon may interact in a negative way with the following medications:
- levothyroxine (a synthetic form of thyroxine);
- Levemir (insulin detemir);
- Lantus (insulin glargine).
Using alcohol with these GLP-1 receptor agonists may cause interactions to occur. Avoid alcohol intake while taking these diabetes medications.
Is It Safe During Pregnancy or Breastfeeding?
It’s unknown whether an unborn baby can be harmed if the mother takes these GLP-1 receptor agonists. Also, it’s not known if these diabetes drugs pass into breast milk. Talk to your healthcare provider if you are pregnant or breastfeeding before taking these GLP-1 receptor agonists.
Trulicity vs Bydureon – Cost
Trulicity (dulaglutide) is a diabetes medicine which is used in adults with type-2 diabetes mellitus to control their blood glucose level. It works by stimulating the body’s natural production of insulin. It is not prescribed to patients with type 1 diabetes.
Bydureon (exenatide) is used alone or with other diabetes medications to improve blood glucose levels for patients with type 2 diabetes. It mimics the action of a naturally occurring hormone GLP-1. It is not insulin and does not substitute for insulin.
In conclusion, the GLP-1 receptor agonists are valuable options for the treatment of type 2 diabetes as monotherapy or as adjunctive therapy as they effectively lower A1C while having a low risk of hypoglycemia. Also, clinical trials demonstrate the superiority of GLP-1 receptor agonists to other antidiabetes medications in blood pressure reduction and weight loss.
Regarding their cost, Trulicity is approximately $770 for a supply of 2 milliliters, whereas the cost for Bydureon is approximately $697 for a supply of 4 powder for injections.
Alternatives to Bydureon and Trulicity
- Exenatide (Byetta);
- Liraglutide (Victoza, Saxenda);
- Semaglutide (Ozempic);
- Lixisenatide (Lyxumia);
- Albiglutide (Tanzeum).
Sources https://www.nejm.org/doi/full/10.1056/NEJMoa1612917 https://www.pbm.va.gov/PBM/clinicalguidance/drugmonographs/Dulaglutide_monograph.pdf http://www.jabfm.org/content/26/2/203.full https://www.astrazeneca-us.com/media/press-releases/2017/bydureon-exscel-trial https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4665063/