Combination Therapy with Trulicity and Januvia for Type 2 Diabetes Management

Introduction to Combination Therapy

The American Diabetes Association and European Association for the Study of Diabetes recommend that GLP-1 receptor agonists like dulaglutide be prioritized over DPP-4 inhibitors like sitagliptin when cardiovascular or renal protection is needed, although the combination of both can be used for type 2 diabetes management 1, 2

The American Diabetes Association recommends that DPP-4 inhibitors like sitagliptin be positioned as second-line agents after metformin, or as alternatives when GLP-1 receptor agonists cannot be used 2
For patients with established atherosclerotic cardiovascular disease, the level of evidence for cardiovascular benefit is greatest for GLP-1 receptor agonists like dulaglutide, making it the preferred incretin-based therapy over DPP-4 inhibitors 1, 3

Both dulaglutide and sitagliptin have low intrinsic hypoglycemia risk when used together, as both work through glucose-dependent mechanisms 2
Sitagliptin requires dose adjustment in renal impairment, while dulaglutide does not require renal dose adjustment 2

The American Diabetes Association suggests considering the combination of dulaglutide and sitagliptin when a patient is already on sitagliptin with inadequate glycemic control and a more potent agent is needed, rather than discontinuing sitagliptin 1
The combination should not be used as a first-line treatment, and dulaglutide alone is preferred over the combination, as the DPP-4 inhibitor adds minimal benefit and additional cost 1, 2