Dulaglutide vs semaglutide: Which GLP-1 is better for blood sugar and weight loss?
While both are GLP-1 medications, the choice between dulaglutide and semaglutide often comes down to a critical tradeoff: the superior weight-loss potency of semaglutide versus the streamlined, user-friendly simplicity of the dulaglutide pen.
Key highlights
- Both semaglutide and dulaglutide are GLP-1 medications with the same mechanism of action. They mimic the action of the GLP-1 hormone to promote satiety, reduce blood glucose levels, promote cardiovascular health, and reduce body weight.
- Dulaglutide is available under the brand name Trulicity, which is FDA-approved for managing type 2 diabetes in children 10 and older, adolescents, and adults, and reducing the risk of cardiovascular events.
- Semaglutide has three brand names: Ozempic, Wegovy, and Rybelsus. The medication is FDA-approved for lowering blood sugar levels in patients with type 2 diabetes, reducing the risk of cardiovascular diseases, and promoting weight reduction.
- Data from clinical trials show that semaglutide is superior to dulaglutide in reducing glycemic control and body weight, but dulaglutide may be more convenient to use.
- Consult a healthcare provider experienced in GLP-1 medications to discuss which medication is more suitable for you. They will create a personalized treatment plan after a detailed assessment and adjust your dosing schedule during follow-ups based on your body’s response.
According to the American Diabetes Association, approximately 40.1 million people have diabetes (diagnosed and undiagnosed) in the United States, which makes up 12% of the population. Similarly, the prevalence of obesity is 40.3% in the U.S, which costs more than $173 billion a year. These statistics show that obesity and diabetes are challenging health conditions. GLP-1 medications such as semaglutide and dulaglutide have shown promising results in managing these health conditions.
Semaglutide and dulaglutide are glucagon-like peptide-1 receptor agonists (GLP-1s) used in the treatment of type 2 diabetes mellitus. Semaglutide is also widely used for chronic weight management and has generally shown larger average reductions in A1c and body weight in head-to-head trials and pooled analyses.
Dulaglutide is marketed under the brand name Trulicity and is FDA-approved for the management of type 2 diabetes. Semaglutide has three brand-name medications: Ozempic, Wegovy, and Rybelsus. Ozempic is a highly effective and popular medication for type 2 diabetes. The medication is also used off-label for weight management.
If you have diabetes or obesity and are trying to choose the right medication, you might wonder if both are weekly GLP-1 injections and what the main differences are that matter to you.
The short answer is that semaglutide and dulaglutide belong to the same drug class and are both used to manage type 2 diabetes. However, semaglutide is more potent than dulaglutide at improving blood sugar control and reducing body weight. The choice of medication depends on your body’s tolerance, cost-effectiveness, insurance coverage, and primary goals such as glycemic control, weight loss, or ease of use.
This guide will compare the effectiveness, side effects, costs, potential risks, benefits, and insurance coverage of semaglutide and dulaglutide to help you make the right choice.
What is Trulicity (dulaglutide)?
Trulicity is a brand-name medication that contains the active ingredient dulaglutide. The medication is a GLP-1 receptor agonist used to improve blood sugar control in adults with type 2 diabetes and reduce cardiovascular risk in certain patients. Besides improving glycemic control, the medication has proven cardiovascular benefits.
Trulicity is a reliable and established medication for managing type 2 diabetes and reducing cardiovascular risk.
What is Ozempic (semaglutide)?
Ozempic has semaglutide as an active ingredient. The medication has the same active molecule as Wegovy, a medication approved for weight loss.
Ozempic is also a GLP-1 receptor agonist, which is FDA-approved for managing type 2 diabetes, reducing the risk of cardiovascular diseases, and preventing kidney failure in patients with chronic kidney disease and type 2 diabetes. This medication is also used off-label for lowering body weight in obese (body mass index 30 or more) and overweight (BMI 27 or more) individuals.
Dulaglutide vs. semaglutide comparison table
Here is a quick comparison of semaglutide and dulaglutide:
| Feature | Ozempic | Trulicity |
|---|---|---|
| Active Ingredient | Semaglutide | Dulaglutide |
| Form | Injectable solution | Injectable solution |
| Dosage | 0.25 mg, 0.5 mg, 1 mg, and 2 mg | 0.75 mg, 1.5 mg, 3 mg, and 4.5 mg |
| Starting Dose | 0.25 mg once weekly (Weeks 1–4) | 0.75 mg once weekly (Weeks 1–4) |
| Titration Schedule | Weeks 1–4: 0.25 mg once weekly Weeks 5–8: 0.5 mg once weekly Weeks 9–12: 1 mg once weekly (if needed) Weeks 13+: 2 mg once weekly (if needed) | Weeks 1–4: 0.75 mg once weekly Weeks 5–8: 1.5 mg once weekly Weeks 9–12: 3 mg once weekly (if needed) Weeks 13+: 4.5 mg once weekly (if needed) |
| Maintenance Dose | 0.5 mg to 2 mg once weekly | 0.75 mg to 4.5 mg once weekly |
| Maximum Dose | 2 mg once weekly | 4.5 mg once weekly |
| Frequency of Use | Once weekly injection | Once weekly injection |
| FDA Approval | Type 2 diabetes, cardiovascular risk reduction, lowering the risk of end stage kidney disease in adults | Type 2 diabetes and cardiovascular risk reduction in children aged 10 or more and adults |
| Effectiveness for HbA1c Reduction | May lower HbA1c more (up to 1.8%) | May lower HbA1c less (up to 1.4%) |
| Effectiveness for Weight Loss | More effective for weight loss (up to 15% of body weight) | Moderate weight loss (3-9%) |
| Kidney Health Benefits | Proven to reduce the risk of kidney disease-related events | No studies yet on kidney-related benefits |
| Maximum Dose | 2 mg once weekly | 4.5 mg once weekly |
| List price (Without Insurance) | $997.58 per month (without insurance) | $987.19 per month |
| Heart Disease Risk Reduction | Reduces major cardiovascular events by 26% in patients with cardiovascular disease | Reduces major cardiovascular events by 12% in patients with cardiovascular risk |
Mechanism and shared benefits
Both medications have the same mechanism of action and similar benefits.
The same class of medication
Semaglutide and dulaglutide are glucagon-like peptide-1 (GLP-1) receptor agonists. These medications mimic the action of an incretin glucagon-like peptide-1 to increase insulin secretion, suppress glucagon, and slow gastric emptying, leading to improved blood sugar control and satiety.
Cardiovascular protection and kidney benefits
Both medications are proven to reduce the risk of Major Adverse Cardiovascular Events (MACE), such as heart attack, stroke, and death due to cardiovascular disease in patients with type 2 diabetes and established heart and blood vessels related diseases.
Semaglutide is indicated for lowering the risk of renal failure in patients with chronic kidney disease and type 2 diabetes. Data from FLOW trials of semaglutide demonstrate that semaglutide slows down the progression of chronic kidney disease in diabetics.
Convenient once-weekly dosing
Both medications are taken once per week as a subcutaneous injection. Once-weekly semaglutide and dulaglutide injections are administered in the abdomen, arms, and thighs. Once weekly injections offer greater adherence compared to older GLP-1 medications that need to be administered daily.
Head-to-head comparison
Direct head-to-head trials are more reliable for comparing the effectiveness, results, and safety profiles. Cross-trial comparisons may have different baseline BMIs, durations, and dosing regimens that affect outcomes. Let’s have a closer look at direct and as cross trials of semaglutide versus dulaglutide:
Blood sugar control (A1c reduction)
In an open-label SUSTAIN 7 clinical trial published in The Lancet, 1,201 patients were divided into four subgroups: semaglutide 0.5 mg (301 patients), semaglutide 1.0 mg (300 patients), dulaglutide 0.75 mg (299 patients), and dulaglutide 1.5 mg (299 patients). Patients taking semaglutide 0.5 mg achieved HbA1c reduction of 1.5% compared to 1.1% with dulaglutide 0.75 mg.
The semaglutide 1.0 mg group showed a weight reduction of 1.8% of body weight compared to 1.4% in the dulaglutide group, which used a 1.5 mg dose. These results indicate that semaglutide was superior to dulaglutide in reducing HbA1c levels at various doses.
A meta-analysis and systematic review compared the effectiveness of semaglutide and dulaglutide for lowering body weight and promoting glycemic control. This analysis included 10 studies. The result showed no difference between the two medications in achieving glycemic control in patients with type 2 diabetes, with an SMD of 0.613. However, semaglutide was more effective in promoting weight loss than dulaglutide in patients with type 2 diabetes, with an SMD of 2.45. This meta-analysis had higher heterogeneity due to different study designs, patient selection criteria, interventions, baseline profiles, and outcomes.
Another analysis showed that semaglutide increases the likelihood of achieving glycemic reduction by more than 2 times compared to other GLP-1 medications.
These statistics show that semaglutide demonstrated a greater A1C control in diabetics compared to dulaglutide in indirect and pooled analysis. However, high doses of dulaglutide (4.5 mg) can achieve comparable glycemic control.
Weight loss
Trulicity (dulaglutide) leads to some weight loss, but it is a secondary benefit of the medication. In clinical studies, the medication showed an average weight reduction of 3-9% of body weight.
In comparison, semaglutide is FDA-approved for weight management under the brand name Wegovy. The medication is indicated for obese and overweight patients with at least one weight-related disease, such as hypertension (high blood pressure), heart disease, dyslipidemia, and high blood cholesterol levels. Wegovy can be used at higher doses (2.4 mg) to promote weight loss. In STEP 1 clinical trials, semaglutide (2.4 mg dose) showed an average weight reduction of 14.9% of body weight after 68 weeks.
In SUSTAIN 7 clinical trials, semaglutide led to greater weight loss than dulaglutide at both high and low doses. Patients lost about 4.6 kg with semaglutide 0.5 mg compared to 2.3 kg with dulaglutide 0.75 mg, and 6.5 kg with semaglutide 1.0 mg compared to 3.0 kg with dulaglutide 1.5 mg. In both comparisons, the semaglutide group demonstrated a significantly greater weight loss, and semaglutide led to more than double the weight reduction compared to dulaglutide at matched doses.
| Efficacy Area | Semaglutide (Ozempic / Wegovy) | Dulaglutide (Trulicity) |
|---|---|---|
| HbA1c reduction (SUSTAIN 7) | −1.5% (0.5 mg) and −1.8% (1.0 mg) | −1.1% (0.75 mg) and −1.4% (1.5 mg) |
| Comparative HbA1c effect | Greater HbA1c reduction at matched doses in head-to-head trial | High doses (4.5 mg) approach semaglutide’s HbA1c reduction |
| Weight loss | Significantly greater (10–15% of body weight) | Modest (3–9% of body weight) |
Dosing, administration, and convenience
Both semaglutide (injectable) and dulaglutide are administered once-weekly. Semaglutide is also available in oral pills in the form of Rybelsus and Wegovy pills. Wegovy pills are used for weight management, while Rybelsus tablets are indicated for controlling blood sugar levels in type 2 diabetes.
Trulicity (dulaglutide) comes in the form of a pre-filled, single-dose pen with an autoinjector that is needle-free, as the needle is inside the pen. No dose dialing is required for the Trulicity pen. Its design is suitable for patients who prefer a simple method of administration.
In comparison, Ozempic comes in a multi-dose pen. Users need to attach a disposable needle and dial the pen manually before injecting. Many patients find handling Ozempic pens more complex compared to the dulaglutide pen. Unlike the Trulicity pen, the needle is visible in the Ozempic pen, which may make patients with needle aversion uncomfortable. However, oral options of semaglutide (Rybelsus and Wegovy pills) are suitable for patients with a strong aversion towards needles. Rybelsus tablets are taken daily on an empty stomach (30 minutes before food).
The PREFER study included 310 participants to assess patients’ preferences for semaglutide and dulaglutide pens. A much higher proportion of participants preferred the dulaglutide device (84.2%) compared with the semaglutide device (12.3%). Similarly, 86.8% felt the dulaglutide device was easier to use, compared with only 6.8% for the semaglutide device. After trying both devices, 93.5% of participants were willing to use the dulaglutide device, compared to 45.8% for the semaglutide device. Training time was also shorter for dulaglutide (3.38 minutes) compared with 8.14 minutes for semaglutide.
Cardiovascular and other outcomes
Semaglutide is approved by the FDA for reducing the risk of major adverse cardiovascular events (MACE) in adults with type 2 diabetes and those with diagnosed heart disease. The medication has potentially greater cardioprotective benefits than Trulicity in patients who are at higher risk of developing heart and blood vessel-related diseases or those with existing cardiovascular issues.
A clinical study compared the results of SUSTAIN 6 and REWIND studies to the effect of semaglutide and dulaglutide on major adverse cardiovascular events (MACE) such as non-fatal heart attack (myocardial infarction, non-fatal stroke, and death due to heart and blood vessel-related diseases. Semaglutide (Ozempic) showed 26% greater reduction in cardiovascular diseases compared to dulaglutide (Trulicity).
Side effects and safety
As semaglutide and dulaglutide have the same mechanism of action, they have similar side effects and safety profiles.
The following are the most common gastrointestinal side effects of these GLP-1 receptor agonists:
- Nausea
- Vomiting
- Diarrhea
- Abdominal discomfort
- Constipation
- Stomach pain
These side effects occur due to delayed gastric emptying. Both medications relax the stomach muscles, which slows peristaltic movement, allowing the food to stay in the stomach longer. Delayed digestion of food gives a feeling of satiety, but it can also cause these gastrointestinal side effects.
Remember, these side effects are usually temporary and subside over time. If they persist, your healthcare provider will adjust your dosage and suggest dietary changes. If these side effects are intolerable, your doctor may suggest discontinuation of the current medication and start another GLP-1 receptor agonist (such as liraglutide or tirzepatide).
Although both medications have the same side effects, the severity varies. Ozempic is more potent, and the incidence or severity of GI side effects can be higher, especially when you start the medication or increase the dose. The following is a comparison of the incidence rates of gastrointestinal adverse events with semaglutide at different doses from randomized controlled trials:
| Adverse Reaction | Placebo (N=262) | OZEMPIC 0.5 mg (N=260) | OZEMPIC 1 mg (N=261) |
|---|---|---|---|
| Diarrhea | 1.90% | 8.50% | 8.80% |
| Constipation | 1.50% | 5.00% | 3.10% |
| Nausea | 6.10% | 15.80% | 20.30% |
| Abdominal pain | 4.60% | 7.30% | 5.70% |
| Vomiting | 2.30% | 5.00% | 9.20% |
Serious events and warnings:
Rare but serious side effects of semaglutide and dulaglutide are:
- Pancreatitis (inflammation of the pancreas)
- Changes in vision (worsening diabetic retinopathy)
- Gallbladder issues (cholecystitis and cholelithiasis)
- Injection site reactions (redness, inflammation, infection, and scarring)
- Severe stomachache
- Suicidal ideation
- Excessive burping
- Mood and behaviour changes
- Hypoglycemia
- Allergic or hypersensitivity reaction
- High risk of aspiration (stomach content entering the respiratory tract) during surgical procedures that require anesthesia or sedation
GLP-1 medications are contraindicated for patients with a personal or family history of medullary thyroid carcinoma and MEN 2 syndrome (Multiple endocrine neoplasia type 2 syndrome). Although no human studies have confirmed the incidence of these carcinomas in humans, some rodent studies showed that GLP-1 medications increase the risk of thyroid cancer. If you experience any symptoms of thyroid tumor, such as a lump or swelling in the neck, difficulty swallowing, difficulty breathing, hoarseness of voice, throat pain, and persistent cough, consult your doctor immediately.
Additionally, if you have a history of pancreatitis or gallbladder issues, inform your doctor before starting these medications, as they might not be suitable for you. If you are already taking glucose-lowering medications such as metformin, insulin, or sulfonylureas, discuss it with your doctor to reduce the risk of hypoglycemia.
Do not take GLP-1 medications if you are lactating, pregnant, or planning to conceive. These medications can not be taken along with oral contraceptives and supplements.
Cost, insurance, and accessibility
The list price of Ozempic is $997.58 for a 28-day supply, $1,349.02 for Wegovy, and $997.58 per package for Rybelsus. In comparison, the wholesale price of Trulicity is $987.19 per month. These medications cost $900–$1,300/month without insurance. According to GoodRx, the average retail price of Ozempic is $1,101.96 per month, and of Trulicity is $1,181.28 per month.
According to GoodRx, the list prices are as follows:
| Pharmacy | Ozempic | Wegovy | Retail Price | Trulicity |
|---|---|---|---|---|
| Walgreens | $995 | $1,390 | $1,030.63 | $1,020 |
| Walmart | $995 | $1,447 | $1,071.43 | $1,031 |
| CVS Pharmacy | $995 | $1,390 | $1,033.85 | $1,019 |
| Costco | $964.99 | $1425 | $1425 | $1,094 |
Most private insurance companies, such as Blue Cross Blue Shield, Aetna, United Healthcare, and Cigna, cover semaglutide and dulaglutide for managing type 2 diabetes. However, most insurance companies do not cover Ozempic (off-label) and Wegovy when these medications are used solely for the reduction of body weight.
Medicare insurance plans also cover semaglutide and dulaglutide for type 2 diabetes management. Medicaid’s coverage for GLP-1 medications varies among different states. Medicaid may cover these medications in a limited quantity or for a limited period. You can confirm your state’s Medicaid formulary to see whether it provides coverage for semaglutide and dulaglutide.
The following states have listed Wegovy as a preferred drug:
- Virginia
- California
- New Hampshire
- Minnesota
- Pennsylvania
- South Carolina
- Rhode Island
- Michigan
- North Carolina
- Massachusetts
- Wisconsin
- Delaware
- Kansas
- Mississippi
How to save on dulaglutide and semaglutide
The following tips can also help lower the costs of these medications:
Ozempic and Wegovy Savings Card
Novo Nordisk offers an Ozempic savings card and a Wegovy savings card for patients with commercial or private insurance that includes Wegovy or Ozempic coverage. These cards allow eligible patients to access a 1-, 2-, or 3-month supply of these medications for as little as $25. To qualify, you must fulfil the following conditions:
- You must be a legal U.S. resident.
- You must be at least 18 years old.
- You should have a valid prescription for Ozempic or Wegovy for an FDA-approved indication
- You are not enrolled in government or state insurance programs such as Medicare, Medicaid, TRICARE, VA, DOD, or Medigap.
NovoCare Patient Assistance Program
Novo Nordisk’s patient assistance program (PAP) offers semaglutide (Ozempic) for free to eligible candidates. This program has free registration, and you do not need to pay any monthly fee.
You can apply for PAP if you meet the following criteria:
- You must be a US citizen or a legal resident in the United States
- Your total household income should be at or less than 400% of the federal poverty rate (FPL).
- You should not be enrolled in federal, state, or government programs such as Medicaid, Veterans Affairs (VA), or low-income subsidies.
If you qualify for other insurance plans like Medicaid, you must sign the patient declaration section of the Patient Assistance Program application and state that you are not enrolled in Medicaid currently and do not plan to get enrolled in the future, and you are not eligible for Medicaid or Medicare Extra Help. You will also need to attach the proof of denial to your application.
Trulicity Savings Card
Eli Lilly, the manufacturer of Trulicity, offers a Trulicity savings card for eligible patients. If you are eligible and have commercial insurance that covers Trulicity, you may need to pay as little as $25 for up to a 3-month supply with the Trulicity Savings Card.
To qualify, you must meet the following eligibility criteria:
- You must have a valid prescription for an FDA-approved use
- You have a commercial insurance that covers Trulicity
- You should not be enrolled in government insurance programs like Medicare, Medicaid, VA, and TRICARE.
- You are 18 years or older
- You are a legal resident in the U.S. or Puerto Rico
The card can be used for 1-, 2-, or 3-month prescriptions. You can get up to 13 fills per year and save $1,950. The program is subject to change and expires on 12/31/2026.
If you do not qualify for these programs, you can also use pharmacy discount cards. Pharmacies like GoodRx, Optum Perks, Singlecare, BuzzRx, and WellRx offer a variety of pharmacy discount coupons for GLP-1 medications. You can save 9-27% of the cash price of these medications with the help of these discount coupons.
Frequently asked questions
Can I switch from Trulicity to Ozempic?
Yes, you can switch from Trulicity to Ozempic, but consult your healthcare provider to make a safe switch. They will provide a personalized dosing schedule according to equivalent doses or start the medication at a low dose.
Which one is better for weight loss?
According to clinical trial data, semaglutide is more effective for promoting weight loss. Trulicity showed an average 3-8% reduction in body weight. In comparison, semaglutide (2.4 mg) reduced 14.9% of body weight after 68 weeks in STEP 1 clinical trials.
Does dulaglutide cause more nausea?
It typically depends on your body’s response to the medication. Both semaglutide and dulaglutide are GLP-1 medications and share similar side effects and safety profiles. As semaglutide is more potent, it may cause more nausea compared to dulaglutide. However, the incidence may vary among individuals.
Are they the same as insulin?
No, semaglutide and dulaglutide are not the same as insulin. These are GLP-1 medications that mimic the actions of the naturally occurring human glucagon-like peptide-1 hormone and bind to GLP-1 receptors to suppress appetite, improve blood sugar control, and reduce body weight.
Is semaglutide better than dulaglutide?
Data from clinical studies demonstrate that semaglutide is more effective than dulaglutide. In the AWARD 11 trial, patients using semaglutide (1 mg weekly) achieved greater weight reduction than those using dulaglutide (3 mg weekly), with a mean difference of approximately 0.24% points. Other clinical studies also show that semaglutide is superior to dulaglutide in reducing body weight and improving blood sugar control.
Will insurance cover Wegovy or Ozempic for obesity?
Insurance companies typically do not cover Wegovy or Ozempic for obesity, as weight management is not considered a medical necessity. It is considered a cosmetic concern. Some insurance companies require prior authorization and cover Wegovy for weight management if you meet the eligibility criteria. Check with your insurance provider before choosing these medications to see whether they are covered.
Do they have the same side effects?
Both are GLP-1 medications and have similar common side effects and safety profiles. However, the severity may differ. As semaglutide is more potent, you may experience greater side effects with semaglutide compared to dulaglutide. Additionally, the incidence of side effects also depends on individuals’ tolerance. If you experience more side effects with semaglutide, dulaglutide may be more suitable, and vice versa.
Conclusion
Semaglutide and dulaglutide are life-changing GLP-1 medications (GLP-1 Ras) with the same mechanism of action and different strengths. Semaglutide has a broader range of indications, such as type 2 diabetes, cardiovascular risk reduction, and lowering the risk of worsening kidney disease in patients with chronic kidney disease and type 2 diabetes. In comparison, dulaglutide is used for managing type 2 diabetes and reducing the risk of cardiovascular events.
Data from clinical trials show that semaglutide is more effective than dulaglutide for promoting glycemic control, reducing body weight, and improving cardiovascular health. However, dulaglutide is more convenient to use because it comes in a single prefilled pen that does not require manual dose selection, unlike semaglutide pens.
If you plan to use GLP-1 medications for weight loss, semaglutide is a better choice because the medication is FDA-approved for this purpose. Comparatively, if you find a semaglutide pen difficult to use or you cannot tolerate the side effects of semaglutide, dulaglutide can be more suitable for you.
Consult with a healthcare professional specialized in endocrinology or a primary care physician experienced in GLP-1 medications and diabetes care to determine the best fit for your metabolic profile.
