Ozempic vs. Trulicity: semaglutide and dulaglutide for type 2 diabetes

Both drugs copy GLP-1, the gut hormone that prompts insulin release after meals, lowers glucagon and slows stomach emptying, and both are injected once a week on any day, with or without food. The molecules differ in how they are made to last: semaglutide binds to albumin in the blood and has a half-life of about a week, while dulaglutide is fused to an antibody fragment and lasts about five days. Ozempic starts at 0.25 mg for four weeks, then 0.5 mg, and can rise to 1 mg and 2 mg after at least four weeks at each step. Trulicity starts at 0.75 mg, can rise to 1.5 mg after four weeks, then in 1.5 mg steps to 3 mg and 4.5 mg. Ozempic comes in multi-dose pens; each Trulicity pen is single-use. Neither is FDA-approved for weight loss, and neither should be combined with another GLP-1 medicine.

SUSTAIN 7, published in The Lancet Diabetes & Endocrinology in 2018, randomized 1,201 adults with type 2 diabetes on metformin to one of four open-label arms for 40 weeks, pairing the low and high doses available at the time: semaglutide 0.5 mg against dulaglutide 0.75 mg, and semaglutide 1.0 mg against dulaglutide 1.5 mg. The low-dose pair lowered HbA1c by 1.5 points against 1.1, and the high-dose pair by 1.8 against 1.4, each a difference of about 0.4 points in semaglutide's favor. Body weight fell by 4.6 kg against 2.3 kg at the low doses and 6.5 kg against 3.0 kg at the high doses. Both drugs have since gained higher doses that the trial did not test. Trulicity's label reports its dose-ranging trial (AWARD-11), where 4.5 mg lowered HbA1c by 1.8 points and weight by 4.6 kg at 36 weeks, against 1.5 points and 3.0 kg on 1.5 mg. Ozempic's label now extends to 2 mg once weekly after at least four weeks on 1 mg. There is no trial of Ozempic 2 mg against Trulicity 4.5 mg, so the top-dose gap is unmeasured.

Nausea, vomiting, diarrhea and abdominal pain lead both labels and ease after the escalation weeks. In SUSTAIN 7, gastrointestinal disorders were reported by 43% on semaglutide 0.5 mg, 44% on 1.0 mg, 33% on dulaglutide 0.75 mg and 48% on dulaglutide 1.5 mg, and they were the most common reason for stopping either drug. Ozempic's label lists nausea in 15.8% on 0.5 mg and 20.3% on 1 mg, against 6.1% on placebo, and vomiting in 5% and 9.2%. Trulicity's label lists nausea in 12.4% on 0.75 mg and 21.1% on 1.5 mg, against 5.3%, plus decreased appetite in 8.6% on 1.5 mg. Both labels warn about low blood sugar with insulin or a sulfonylurea, diabetic retinopathy complications, pancreatitis and gallbladder disease, and both carry the rodent thyroid C-cell tumor boxed warning with the MTC and MEN 2 contraindication.

Ozempic suits adults who need a larger drop in HbA1c or more weight loss than Trulicity has shown at comparable doses, and it is the only one of the two with a label to slow kidney decline in type 2 diabetes with chronic kidney disease, based on the FLOW trial. Its cardiovascular indication requires established heart or vascular disease. Trulicity suits children and teens aged 10 to 17, since Ozempic is not approved under 18, and adults without established cardiovascular disease but with multiple risk factors, the population its REWIND trial covered. Some people also prefer a fresh single-dose pen each week to a multi-dose pen. Price varies with insurance. NovoCare lists Ozempic at $349 a month self-pay for 0.25 mg to 1 mg and $499 for 2 mg (NovoCare Ozempic price guide, May 2026 edition, checked 28 Sep 2026). Lilly's Trulicity savings card lists $25 for up to three months with qualifying commercial insurance (trulicity.com savings page, checked 28 Sep 2026); we did not find a Lilly self-pay price. Neither suits someone with a personal or family history of medullary thyroid carcinoma or MEN 2, or severe gastroparesis.