Abstract Dulaglutide is an effective Glucagon-like Peptide-1 (GLP-1) Receptor Agonist (RA) in optimizing weight and glycemic control in obese patients with Type 2 Diabetes Mellitus (T2DM). The study's objective was the real-world evaluation of the metabolic effect of Dulaglutide on weight and glycemic control in patients with T2DM from Southern Iraq. This study is a six-month obser- vational prospective longitudinal evaluation of 185 obese individ- uals with T2DM. They were initiated on Dulaglutide as an add-on drug with Oral Antidiabetic (OAD) or insulin therapy. General characteristics of the patients, glycated hemoglobin (HbA1c), blood glucose, lipid profile, and side effects profile were evaluated at the enrollment and the end of the study. The enrolled 185 obese patients with T2DM, had a T2DM duration (2 -14 years) and ini- tial HbA1c range (6 - 19.5%), with different treatment modalities, including insulin, OADs, or both. The study showed a significant reduction in weight, HbA1c, and serum cholesterol, with minimal hypoglycemic events in 5% of patients (n=9). The gastrointestinal side effects were mild to moderate and self-limited in >96% of patients (n=178), while they were so severe in 4% (n=7) and caused discontinuation of Dulaglutide. Therefore, the insulin reg- imen was either stopped (n=28), changed (n=7), or reduced (n=9). No change on oral medications was performed in 141 patients. In conclusion, Dulaglutide 1.5 mg administered once a week signifi- cantly reduced the weight, HbA1c, Self-Monitoring of Blood Glucose (SMBG), and cholesterol levels with minimal hypo- glycemic risk. Introduction Glucagon-Like Peptide-1 Receptor Agonists (GLP-1RAs) are effective therapies for the treatment of type 2 diabetes. 1 Recent guideline placed GLP-1 RA as second-and third-line therapy. 2 The most popular GLP1-RA, Dulaglutide, acts by increasing glucose-dependent insulin secretion, decreasing glucagon release, inhibiting hepatic gluconeogenesis, slowing gastric emptying, and centrally suppressing appetite. These effects are dose-dependent, which makes Dulaglutide more beneficial in individuals who need better control of their glycated hemoglobin (HbA1c), Fasting Plasma Glucose (FPG), and Postprandial Plasma Glucose (PPG) excursions, along with weight reduction, with its minimal hypo- glycemic effect. 3-5 Dulaglutide as monotherapy reduces HbA1c levels by 0.5% to 0.8%. Higher dosages do not provide a further significant decrease in HbA1c, 6 the combination with metformin and dulaglutide low- ers HbA1c levels by 0.7% to 1.0%; greater reduction in HbA1c values was observed among patients with higher HbA1c values at baseline. 7 Clinical trials reported gastrointestinal-related side effects Correspondence: Samih A. Odhaib, Adult endocrinologist and diabetologist, Thi Qar Specialized Diabetes, Endocrine and Metabolism Center (TDEMC), Thi Qar Health Directorate, 64001 Thi Qar, Iraq. Tel.: 009647816787885. E-mail: samihabed@yahoo.com Key words: dulaglutide; glycated hemoglobin; type 2 diabetes melli- tus; weight. Conflict of interest: the authors declare no conflict of interest. Funding: none. Availability of data and materials: all data generated or analyzed dur- ing this study are included in this published article. Ethics approval and consent to participate: the Ethics Committee of Thi Qar Specialized Diabetes, Endocrine and Metabolism Center (TDEMC) approved this study (TDEMC/D/2021/9/6). The study is conformed with the Helsinki Declaration of 1964, as revised in 2013, concerning human and animal rights. All patients participating in this study signed a written informed consent form for participating in this study. Informed consent: written informed consent was obtained from a legally authorized representative(s) for anonymized patient informa- tion to be published in this article. Received: 29 May 2022. Accepted: 30 December 2022. Early view: 16 February 2023. Publisher’s note: all claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organi- zations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher. © Copyright: the Author(s), 2023 Licensee PAGEPress, Italy Journal of Biological Research 2023; 96:10643 doi:10.4081/jbr.2023.10643 This article is distributed under the terms of the Creative Commons Attribution-NonCommercial International License (CC BY-NC 4.0) which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author(s) and source are credited. [Journal of Biological Research 2023; 96:10643] [page 17] Journal of Biological Research 2023; volume 96:10643 Effect of dulaglutide injection on weight beyond glycemic control: real-world observational study Adel G. Mohammed, 1,2 Samih A. Odhaib 1 1 Adult endocrinologist, Thi Qar Specialized Diabetes Endocrine and Metabolism Center (TDEMC), Thi Qar Health Directorate, Thi Qar, Iraq; 2 Diabetes, Endocrine and Metabolism Division, Department of Medicine, College of Medicine, University of Thi-Qar, Thi Qar, Iraq Non-commercial use only