Dulaglutide vs semaglutide: in the head-to-head SUSTAIN 7 trial, weekly semaglutide (Ozempic) lowered HbA1c by 1.8 points versus 1.4 for dulaglutide (Trulicity) at their top doses then, and body weight by 6.5 kg versus 3.0 kg over 40 weeks.[1] Both are weekly injections for type 2 diabetes with heart-protection indications; neither Trulicity nor Ozempic is approved for weight loss.[2][3]
See our dulaglutide and semaglutide profiles for each drug’s history, or browse the GLP-1 drugs hub.
Dulaglutide vs semaglutide at a glance
| Dulaglutide (Trulicity) | Semaglutide (Ozempic) | |
|---|---|---|
| Maker | Eli Lilly | Novo Nordisk |
| Dosing | Once weekly[2] | Once weekly[3] |
| Doses | 0.75, 1.5, 3, 4.5 mg[2] | 0.25, 0.5, 1, 2 mg[3] |
| Half-life | About 5 days[2] | About 1 week[3] |
| Children | Ages 10 and up[2] | Not approved for children |
| Heart indication | Established heart disease or multiple risk factors[2] | Established heart disease[3] |
| Kidney indication | No | Yes, in chronic kidney disease[3] |
| Weight-loss version | None | Wegovy[11] |
| SUSTAIN 7 HbA1c (top doses) | −1.4[1] | −1.8[1] |
| SUSTAIN 7 weight (top doses) | −3.0 kg[1] | −6.5 kg[1] |
How they differ in design
Both drugs copy GLP-1, a gut hormone that raises insulin after meals, lowers glucagon, slows stomach emptying and reduces appetite. They are built differently to last a week:
- Dulaglutide joins two GLP-1-like peptides to a fragment of an antibody. The large size slows its removal from the body, giving a half-life of about 5 days.[2]
- Semaglutide is a single modified GLP-1 peptide with a fatty side chain that binds albumin, a protein in the blood, giving a half-life of about a week.[3]
In practice, both are injected once a week from a prefilled pen at any time of day, with or without meals.[2][3] The design difference matters less than the dose: semaglutide at its approved doses produces a stronger effect on blood sugar and weight than dulaglutide at its approved doses.[1]
Trulicity vs Ozempic: the SUSTAIN 7 trial
SUSTAIN 7 randomized 1,201 adults with type 2 diabetes on metformin to one of four weekly treatments for 40 weeks.[1]
| Comparison | HbA1c change | Weight change |
|---|---|---|
| Semaglutide 0.5 mg | −1.5 | −4.6 kg |
| Dulaglutide 0.75 mg | −1.1 | −2.3 kg |
| Semaglutide 1.0 mg | −1.8 | −6.5 kg |
| Dulaglutide 1.5 mg | −1.4 | −3.0 kg |
At both dose levels semaglutide was superior on HbA1c and weight.[1] Stomach side effects were the most common adverse events: 43% and 44% on the two semaglutide doses, 33% on dulaglutide 0.75 mg and 48% on dulaglutide 1.5 mg.[1]
Higher doses: Trulicity 4.5 mg and Ozempic 2 mg
- Trulicity (AWARD-11): at 36 weeks, dulaglutide 4.5 mg lowered HbA1c by 1.77 points and weight by 4.6 kg, versus 1.54 points and 3.0 kg on 1.5 mg.[4]
- Ozempic (SUSTAIN FORTE): at 40 weeks, semaglutide 2 mg lowered HbA1c by 2.1 to 2.2 points and weight by 6.4 to 6.9 kg.[5]
These come from separate trials with different populations, so treat the comparison as rough.
Heart and kidney outcomes
- Trulicity (REWIND): in 9,901 people aged 50 and over, most without established heart disease, heart attack, stroke or cardiovascular death occurred in 12.0% on dulaglutide versus 13.4% on placebo over a median 5.4 years.[6]
- Ozempic (SUSTAIN-6): in 3,297 people at high heart risk, those events occurred in 6.6% versus 8.9%.[7]
- Ozempic (FLOW): semaglutide lowered major kidney events by 24% in type 2 diabetes with chronic kidney disease.[8]
Dulaglutide has also served as the comparison drug in newer trials: in SURPASS-CVOT, tirzepatide was non-inferior to dulaglutide on heart outcomes, not superior.[12]
Trulicity for weight loss
Trulicity is approved only for blood sugar control and heart-risk reduction in type 2 diabetes.[2] Weight loss is a side effect, and a modest one: 3.0 kg at 1.5 mg and 4.6 kg at 4.5 mg in AWARD-11.[4] By comparison, semaglutide at the Wegovy dose of 2.4 mg produced 14.9% average weight loss in people without diabetes.[10]
People who want a GLP-1 mainly for weight loss are usually prescribed a drug approved for it, such as Wegovy.[11] See our liraglutide vs semaglutide guide for another older option.
Side effects
From the Trulicity label, nausea affected 12.4% on 0.75 mg and 21.1% on 1.5 mg versus 5.3% on placebo; vomiting 6.0% and 12.7% versus 2.3%.[2] In REWIND, 47.4% on dulaglutide reported a stomach side effect over about 5 years versus 34.1% on placebo.[6] Both drugs share the boxed warning about thyroid C-cell tumors in rodents and warnings about pancreatitis, gallbladder disease and low blood sugar when combined with insulin or sulfonylureas.[2][3]
Dosing and missed doses
| Trulicity | Ozempic | |
|---|---|---|
| Start | 0.75 mg weekly[2] | 0.25 mg weekly (not a treatment dose)[3] |
| Increase | To 1.5 mg after 4 weeks, then by 1.5 mg every 4+ weeks[2] | To 0.5 mg after 4 weeks, then 1 mg and 2 mg[3] |
| Maximum | 4.5 mg[2] | 2 mg[3] |
| Missed dose | Take if 3+ days until the next dose[2] | Take within 5 days of the missed dose[3] |
There is no official conversion between the two. A prescriber chooses the starting dose when switching.
What happens in everyday practice
Trials enroll selected patients, so researchers also look at routine care. In the 2026 UK primary-care study, almost 30% of people starting either drug stopped early, and those who stopped had more stomach side effects and smaller benefits. Among people who stayed on treatment, semaglutide still produced more HbA1c and weight reduction, including in the 88% of patients who would not have qualified for SUSTAIN 7.[9] Observational studies like this can be skewed by who gets prescribed which drug, but the direction matched the randomized trial.
Which one?
- Largest HbA1c and weight reduction: semaglutide.
- Children aged 10 and up: dulaglutide is approved; Ozempic is not.[2]
- Kidney disease with type 2 diabetes: Ozempic has the labeled indication.[3]
- Cost and coverage: formularies differ; see Trulicity cost without insurance.
A clinician should make the choice based on your health history and coverage.
