Type 2 diabetes (T2D) and heart health have a complex and dependent relationship. New data presented at ACC 2026 suggests that dulaglutide may be doing something far more dramatic than managing diabetes: it may be stabilising coronary plaques from the inside out.
In a small, prospective randomised study of 39 people with T2D and intermediate coronary stenoses (25%–75%), patients were assigned either to usual care or to once‑weekly dulaglutide, a glucagon‑like peptide‑1 receptor agonist (GLP‑1RA). Using high‑resolution optical coherence tomography at baseline and nine months, investigators tracked two key features of plaque vulnerability: lipid index (LI), reflecting how “fatty” the plaque is, and minimum fibrous cap thickness (FCT), the fragile “skin” whose rupture triggers heart attacks.
Despite starting with similar plaque profiles, the dulaglutide group showed significantly greater regression in lipid index and a larger increase in fibrous cap thickness than standard therapy alone. At the same time, glycaemic stability appeared to improve: time spent in a tight glucose range trended upwards with dulaglutide, and tighter glucose control correlated with greater reductions in plaque lipid (an inverse relationship between change in TITR and change in LI).
By smoothing out glucose swings and directly remodelling plaque architecture, dulaglutide is transforming vulnerable coronary lesions into more stable structures, which provides physical evidence for their powerful cardiovascular protection. According to GlobalData’s Pharma Intelligence Center, there are 25 Phase III candidates, 52 Phase II candidates, and 80 Phase I candidates for T2D globally.
