Trulicity and Ozempic are the two once-weekly GLP-1 injections for type 2 diabetes that are most often weighed against each other. Unlike Wegovy and Ozempic or Mounjaro and Zepbound, they are genuinely two drugs: different molecules, different manufacturers, different chemistry. So a comparison is possible, and one was run. What is interesting is how little of the current prescribing it now covers.
Labels read on 23 September 2026 from DailyMed: OZEMPIC injection (Novo Nordisk, NDA 209637, SPL effective 1 June 2026) and TRULICITY (Eli Lilly, BLA 125469, SPL effective 16 June 2026). Trial figures from the SUSTAIN 7 publication and registry record. Nothing here is a dose recommendation; the labels' dosing is reported on our titration schedules page.
Two different molecules, two different kinds of approval
| Trulicity | Ozempic | |
|---|---|---|
| Molecule | dulaglutide | semaglutide |
| Maker | Eli Lilly | Novo Nordisk |
| What it is | Fusion protein: two GLP-1 analogue chains on an antibody Fc fragment | Modified peptide, bound to albumin in the blood |
| Similarity to human GLP-1 | 90% of amino-acid sequence | 94% |
| Application type | Biologics License Application, BLA 125469 | New Drug Application, NDA 209637 |
| Strengths | 0.75, 1.5, 3, 4.5 mg | 0.25/0.5, 1, 2 mg |
| Blood-sugar control | Adults, and children 10 and older | Adults |
| Heart-risk indication | Established cardiovascular disease or multiple risk factors | Established cardiovascular disease |
| Kidney-outcomes indication | No | Yes (chronic kidney disease, FLOW trial) |
Two lines are worth reading twice. Trulicity's heart indication covers a wider population than Ozempic's — it reaches people with risk factors but no established disease, because its outcome trial (REWIND) enrolled them. And Trulicity is licensed as a biologic because it is a protein: the label describes two identical chains, each a GLP-1 analogue linked to the Fc portion of a modified human IgG4 heavy chain. That is why it carries a BLA number while every semaglutide product carries an NDA. How far apart the class's molecules are in size — from a small molecule to a 63-kilodalton fusion protein — is set out on our is GLP-1 a peptide page.
The one head-to-head
SUSTAIN 7 (Pratley et al., Lancet Diabetes & Endocrinology 2018; NCT02648204) randomised 1,201 adults with type 2 diabetes on metformin to one of four arms for 40 weeks. It was open-label — patients and doctors knew which drug was given — and funded by Novo Nordisk, Ozempic's maker.
| 40 weeks | Semaglutide 0.5 mg | Dulaglutide 0.75 mg | Semaglutide 1 mg | Dulaglutide 1.5 mg |
|---|---|---|---|---|
| Patients exposed | 301 | 299 | 300 | 299 |
| HbA1c change | −1.5 points | −1.1 points | −1.8 points | −1.4 points |
| Difference | −0.40 (−0.55 to −0.25) | −0.41 (−0.57 to −0.25) | ||
| Weight change | −4.6 kg | −2.3 kg | −6.5 kg | −3.0 kg |
| Difference | −2.26 kg (−3.02 to −1.51) | −3.55 kg (−4.32 to −2.78) | ||
| Any gastrointestinal event | 43% | 33% | 44% | 48% |
Semaglutide won on both measured outcomes at both dose pairs. On weight, it roughly doubled the loss.
The side-effect row is the one people skip, and it does not point one way. At the lower doses dulaglutide had fewer stomach complaints (33% against 43%). At the higher doses it had more (48% against 44%) while losing less weight. Stomach effects in this trial did not track weight loss between drugs.
What neither label says
Here is the finding a reader of either label would not guess. SUSTAIN 7 appears in neither.
- The Ozempic injection label's clinical-studies section reports active-comparator trials against sitagliptin, exenatide 2 mg once weekly and insulin glargine, plus Ozempic 2 mg against 1 mg.
- The Trulicity label reports active-comparator trials against sitagliptin, exenatide twice daily and insulin glargine, plus 3 mg and 4.5 mg against 1.5 mg.
Each label chose three comparators, overlapping on two of them, and neither chose the other. SUSTAIN 7 was a post-approval phase 3b study, and it has not been added to either label. The practical result is that the one randomised answer to "Trulicity or Ozempic?" exists only in a journal, not in either document a prescriber is handed.
The doses the head-to-head never reached
SUSTAIN 7 compared the doses that existed in 2016. Both drugs have climbed since.
| Tested head-to-head | Current top strength | Label's trial at the top strength | |
|---|---|---|---|
| Trulicity | 0.75 mg, 1.5 mg | 4.5 mg | 1.5 vs 3 vs 4.5 mg, 36 weeks: weight −3.0, −3.8, −4.6 kg; HbA1c −1.5, −1.6, −1.8 points |
| Ozempic | 0.5 mg, 1 mg | 2 mg | 1 vs 2 mg, 40 weeks: weight −5.6, −6.4 kg; HbA1c −1.9, −2.1 points |
Those two right-hand cells are separate trials with separate people, different durations and different baselines. Setting them side by side is not a comparison, and no randomised trial has compared Trulicity 4.5 mg with Ozempic 2 mg.
What exists instead are indirect comparisons — statistical models that bridge two trials through a shared arm. The first (Pratley et al., Diabetes, Obesity and Metabolism 2021, PMID 34286894) linked SUSTAIN 7 to Lilly's dose trial and estimated that semaglutide 1 mg lowered HbA1c by about the same as dulaglutide 4.5 mg (difference −0.07 points, interval −0.26 to 0.12, not significant) and weight by about 2 kg more (−1.95 kg, −2.87 to −1.03). A second (Lingvay et al., 2022, PMID 34922383) compared semaglutide 2 mg with dulaglutide 3 and 4.5 mg. Four of the first paper's nine authors are Novo Nordisk employees, and its conflict statement says so; the models are Novo's, built from Novo's head-to-head. That does not make them wrong. It does mean the evidence at current doses comes from one side.
The registry, counted
A ClinicalTrials.gov search for studies listing both dulaglutide and semaglutide as interventions, run on 23 September 2026, returns 32 records. Most are observational studies, surgery and endoscopy studies that mention both as drugs to be paused, or academic comparisons of the class. The manufacturer-sponsored comparisons among them, by title:
- Novo Nordisk: SUSTAIN 7 (NCT02648204); oral semaglutide against dulaglutide (NCT03015220); injection-site pain with semaglutide against dulaglutide (NCT04189848).
- Eli Lilly: a comparison of the dulaglutide pen with the semaglutide pen (NCT03724981).
Each manufacturer ran the comparison it chose. Novo compared outcomes; Lilly compared devices.
Side effects, from each label's own table
Neither label compares itself with the other, but each publishes its own placebo-controlled pool with dose columns.
| Reaction | Trulicity placebo | 0.75 / 1.5 mg | Ozempic placebo | 0.5 / 1 mg |
|---|---|---|---|---|
| Nausea | 5.3% | 12.4 / 21.1% | 6.1% | 15.8 / 20.3% |
| Vomiting | 2.3% | 6.0 / 12.7% | 2.3% | 5.0 / 9.2% |
| Diarrhoea | 6.7% | 8.9 / 12.6% | 1.9% | 8.5 / 8.8% |
| Any gastrointestinal reaction | 21% | 32 / 41% | 15.3% | 32.7 / 36.4% |
At the top original doses the nausea rates are almost identical — 21.1% and 20.3% — which is consistent with SUSTAIN 7's finding that stomach effects did not separate the drugs cleanly. Trulicity's newer doses add little: in its 1.5 / 3 / 4.5 mg trial nausea ran 13.4%, 15.6% and 16.4%. Both labels share the class warnings — thyroid C-cell tumours in rodents, pancreatitis, gallbladder disease, low blood sugar with insulin or sulfonylureas, kidney injury from dehydration, diabetic retinopathy complications, and aspiration during anaesthesia — and our GLP-1 side effects page and dose and side effects page cover the class record.
What this page cannot tell you
- Which drug suits a particular person. Indication, kidney function, heart history, age, coverage and tolerance all bear on it, and none of them is in a table.
- How the current top doses compare. No trial has randomised people between Trulicity 4.5 mg and Ozempic 2 mg.
- Anything about weight-loss use. Neither drug is approved for it. For the class's weight-loss evidence, see tirzepatide against semaglutide and the Mounjaro and Ozempic comparison.
Sources
- OZEMPIC (semaglutide) injection, prescribing information, Novo Nordisk, NDA 209637, SPL effective 2026-06-01 — DailyMed, read 2026-09-23: sections 1, 3, 6.1, 11 and 14.
- TRULICITY (dulaglutide) injection, prescribing information, Eli Lilly, BLA 125469, SPL effective 2026-06-16 — DailyMed, read 2026-09-23: sections 1, 3, 6.1, 11, 12.3 and 14.
- Pratley RE, Aroda VR, Lingvay I, et al. Semaglutide versus dulaglutide once weekly in patients with type 2 diabetes (SUSTAIN 7). Lancet Diabetes Endocrinol. 2018;6(4):275-286. PubMed 29397376
- Pratley RE, Catarig AM, Lingvay I, et al. An indirect treatment comparison of the efficacy of semaglutide 1.0 mg versus dulaglutide 3.0 and 4.5 mg. Diabetes Obes Metab. 2021;23(11):2513-2520. PubMed 34286894 — conflict-of-interest statement read.
- Lingvay I, Bauer R, Baker-Knight J, et al. An Indirect Treatment Comparison of Semaglutide 2.0 mg vs Dulaglutide 3.0 mg and 4.5 mg. J Clin Endocrinol Metab. 2022;107(5):1461-1469. PubMed 34922383
- ClinicalTrials.gov API v2, interventions "dulaglutide AND semaglutide", run 2026-09-23: 32 records.