Semaglutide vs dulaglutide

Side by side

Semaglutide High and dulaglutide High copy GLP-1, the gut hormone that raises insulin after meals, slows the stomach and reduces appetite. Both are injected once a week. They are built differently: semaglutide is a modified GLP-1 peptide with a half-life of about a week, while dulaglutide is a GLP-1 analogue fused to part of a human antibody, an IgG4 Fc fragment, which gives it a half-life of about five days ^{1 2}. The table is read from our encyclopedia entries.

SUSTAIN 7: the direct comparison

SUSTAIN 7 randomised 1,201 adults with type 2 diabetes on metformin, at 194 sites in 16 countries, to one of four weekly treatments for 40 weeks: semaglutide 0.5 mg, dulaglutide 0.75 mg, semaglutide 1.0 mg or dulaglutide 1.5 mg. It paired the low doses and the high doses, which were the standard doses of each drug at the time ³.

At the low doses, HbA1c fell by 1.5 percentage points on semaglutide against 1.1 on dulaglutide; at the high doses, by 1.8 against 1.4. The differences, about 0.4 points, were statistically significant at both levels. Weight fell by 4.6 kg against 2.3 kg at the low doses and by 6.5 kg against 3.0 kg at the high doses ³. Gastrointestinal disorders were the most common side effects for both drugs and the most common reason for stopping: they affected 43% and 44% on the two semaglutide doses, 33% on dulaglutide 0.75 mg and 48% on dulaglutide 1.5 mg ³. The trial was open label and paid for by Novo Nordisk, which makes semaglutide.

The doses have moved on since

Both drugs now go higher than SUSTAIN 7 tested. Dulaglutide's AWARD-11 trial compared 3.0 mg and 4.5 mg with 1.5 mg in adults on metformin; at 36 weeks the 4.5 mg dose lowered HbA1c by 1.77 points against 1.54 and weight by 4.6 kg against 3.0 kg, with more nausea at the higher doses ⁴. Semaglutide's diabetes doses reach 2 mg, and its weight-management dose is 2.4 mg, according to our entry ². No trial has compared the two drugs at those top doses, so the SUSTAIN 7 gap is the best direct evidence there is, and it was measured at doses lower than many people now take.

Heart and kidney outcomes

Both drugs have large outcome trials, but in different people, so they cannot be ranked against each other from these results. REWIND followed 9,901 people with type 2 diabetes for a median of 5.4 years: cardiovascular death, heart attack or stroke occurred in 12.0% on dulaglutide 1.5 mg against 13.4% on placebo, a hazard ratio of 0.88 ⁵. Most REWIND participants had cardiovascular risk factors rather than established heart disease, which is why its result supported a broad cardiovascular indication.

For semaglutide, SELECT tested the 2.4 mg weight-management dose in 17,604 adults with established cardiovascular disease and overweight or obesity but no diabetes, and found a 20% reduction in major cardiovascular events over 3.3 years ⁶. FLOW tested semaglutide 1.0 mg in people with type 2 diabetes and chronic kidney disease and reduced a composite of kidney failure and related outcomes by 24%; it stopped early for efficacy ⁷.

Weight, children and who each is for

The clearest practical difference is weight. Semaglutide is approved at higher doses as Wegovy for weight management, and in STEP 1 the 2.4 mg dose lowered weight by 14.9% at 68 weeks against 2.4% on placebo in adults without diabetes ⁸. Dulaglutide's approval is for type 2 diabetes, in adults and in children 10 years and older, and for reducing cardiovascular events in adults with type 2 diabetes and heart disease or risk factors ⁹. In AWARD-PEDS, in 10- to 17-year-olds over 26 weeks, HbA1c rose 0.6 points on placebo and fell 0.6 and 0.9 points on dulaglutide 0.75 and 1.5 mg ¹⁰.

Semaglutide also comes as a daily tablet, Rybelsus, approved in 2019 ²; dulaglutide is injection only.

How the differences add up (as of October 2, 2026)

Head to head, at the doses tested, semaglutide lowered blood sugar and weight more than dulaglutide with a similar rate of gastrointestinal side effects at the higher doses. Both have outcome-trial evidence: dulaglutide for cardiovascular events in a broad diabetes population, semaglutide for cardiovascular events in people with obesity and for kidney outcomes in diabetic kidney disease. Semaglutide carries a weight-management approval and an oral form; dulaglutide adds an approval for type 2 diabetes in children from age 10. Both are prescription drugs approved in the US. Which suits a given person is a decision for their prescriber, and doses on this page are those studied in trials, not recommendations.

Frequently asked questions

Is Ozempic better than Trulicity?

In SUSTAIN 7, the only head-to-head trial, semaglutide (Ozempic) lowered HbA1c by 1.8 points against 1.4 and weight by 6.5 kg against 3.0 kg at the higher doses tested, over 40 weeks. Newer, higher doses of both drugs have not been compared directly.

Does dulaglutide cause weight loss?

Yes, though less than semaglutide in SUSTAIN 7. In AWARD-11, dulaglutide 4.5 mg lowered weight by 4.6 kg at 36 weeks against 3.0 kg on 1.5 mg. It is approved for type 2 diabetes, not for weight management.

Do both protect the heart?

Both have positive outcome trials in different populations: dulaglutide in REWIND (cardiovascular events 12.0% against 13.4%) and semaglutide in SELECT (20% fewer major cardiovascular events in people with obesity and heart disease).

Related on Grey Peptides

• Semaglutide
• Dulaglutide
• Semaglutide vs liraglutide

Sources

1. Sanford, M. (2014). Dulaglutide: first global approval. Drugs, 74(17), 2097-103. PMID: 25367716
2. Grey Peptides dataset records for both compounds (status, half-life and studied doses as sourced on each entry); read October 2, 2026.
3. Pratley, R. E., et al. (2018). Semaglutide versus dulaglutide once weekly in patients with type 2 diabetes (SUSTAIN 7): a randomised, open-label, phase 3b trial. Lancet Diabetes Endocrinol, 6(4), 275-286. PMID: 29397376
4. Frias, J. P., et al. (2021). Efficacy and Safety of Dulaglutide 3.0 mg and 4.5 mg Versus Dulaglutide 1.5 mg in Metformin-Treated Patients With Type 2 Diabetes in a Randomized Controlled Trial (AWARD-11). Diabetes Care, 44(3), 765-773. PMID: 33397768
5. Gerstein, H. C., et al. (2019). Dulaglutide and cardiovascular outcomes in type 2 diabetes (REWIND): a double-blind, randomised placebo-controlled trial. Lancet, 394(10193), 121-130. PMID: 31189511
6. Lincoff, A. M., et al. (2023). Semaglutide and Cardiovascular Outcomes in Obesity without Diabetes. N Engl J Med, 389(24), 2221-2232. PMID: 37952131
7. Perkovic, V., et al. (2024). Effects of Semaglutide on Chronic Kidney Disease in Patients with Type 2 Diabetes. N Engl J Med, 391(2), 109-121. PMID: 38785209
8. Wilding, J. P. H., et al. (2021). Once-Weekly Semaglutide in Adults with Overweight or Obesity. N Engl J Med, 384(11), 989-1002. PMID: 33567185
9. Grey Peptides dataset, dulaglutide record: Trulicity (BLA 125469, approved September 18, 2014) and its current label's indications (published August 10, 2026); read October 2, 2026.
10. Arslanian, S. A., et al. (2022). Once-Weekly Dulaglutide for the Treatment of Youths with Type 2 Diabetes. N Engl J Med, 387(5), 433-443. PMID: 35658022

Educational information, not medical advice. Each dose in this guide names its source, an approved label or a published study. None is a recommendation for you. An unapproved compound has no established safe or effective human dose, and products sold for “research use only” are not made or tested for people. Talk to a doctor before acting on anything on this site, including before you start, stop or change any medicine or dose.