Ozempic vs Trulicity: Which Weekly GLP-1 Does More for Weight & A1C

In the only head-to-head trial of trulicity vs ozempic, Ozempic did more for blood sugar and weight. SUSTAIN 7 randomized 1,201 adults with type 2 diabetes already taking metformin. After 40 weeks, A1C fell 1.8 points on Ozempic 1 mg against 1.4 on Trulicity 1.5 mg, and weight fell 6.5 kg against 3.0 kg (Lancet Diabetes Endocrinol, 2018). The lower dose pair showed the same pattern.

SUSTAIN 7 was open-label, funded by Ozempic's maker, and did not test the newer, higher doses, Trulicity 3 and 4.5 mg or Ozempic 2 mg. Even so, the ADA's 2026 Standards of Care rank semaglutide above dulaglutide for glucose lowering and weight loss.

Dulaglutide vs semaglutide is a comparison inside one drug class, so the differences are size of effect, dosing and labeling, not mechanism. The MedlinePlus dulaglutide injection information page covers Trulicity's basics for patients.

A1C lowering in head-to-head trials

Starting from an average A1C of 8.2%, Ozempic lowered it more than Trulicity at both SUSTAIN 7 dose pairs, by about 0.4 points each time.

The newer doses have only indirect comparisons. In AWARD-11, its own 36-week trial, Trulicity 4.5 mg lowered A1C 1.8 points against 1.5 on 1.5 mg. Analyses by Ozempic's maker put Ozempic 1 mg roughly level with Trulicity 4.5 mg on A1C, and Ozempic 2 mg somewhat ahead. Our article on semaglutide & A1C over time explains how clinicians track that progress.

Weight loss on each drug

Trulicity weight loss is real but modest. In AWARD-11, people on 1.5, 3 and 4.5 mg lost 3.0, 3.8 and 4.6 kg over 36 weeks (Trulicity prescribing information).

Neither drug is FDA-approved for weight loss, so there is no Trulicity dosage for weight loss and no dulaglutide weight-loss product. Trulicity for weight loss means a diabetes drug with a secondary weight effect. Semaglutide is different. Ozempic produced 4.6 to 6.5 kg in SUSTAIN 7 and 6.4 kg on 2 mg in its own 40-week trial, and its weight-management version, Wegovy, produced 14.9% average weight loss in adults without diabetes in STEP 1.

Dosing & weekly pens

Trulicity starts at 0.75 mg once a week and can rise to 1.5 mg after 4 weeks, then in 1.5 mg steps at least 4 weeks apart to a maximum of 4.5 mg. Each weekly dose has its own single-dose pen.

Ozempic starts at 0.25 mg for 4 weeks, then 0.5 mg, with steps to 1 mg and 2 mg at least 4 weeks apart. One pen holds several weekly doses, with a new needle each time. Either drug can be taken any time of day, with or without food.

Side effects rise with the dose. In SUSTAIN 7, stomach and gut problems affected 43% to 44% of people on Ozempic and 33% to 48% on Trulicity, the most common reason anyone stopped. Early stops for side effects were more common on Ozempic. In the body, Trulicity lasts about 5 days and Ozempic about a week, so a missed Trulicity dose can be taken if 3 days remain before the next, and a missed Ozempic dose within 5 days.

Price & access for weight loss

Both labels cover type 2 diabetes only, so using either for weight alone is off label. List prices sit close: the ADA's 2026 tables put a month of Trulicity 4.5 mg at $1,185 and Ozempic 2 mg at $1,197 before discounts (ADA Standards of Care, Section 9).

A November 2025 federal pricing agreement set Trulicity at $389 a month and Ozempic at $350 through TrumpRx. Harbor's weight program uses compounded semaglutide from $99 a month, prepared for you by name at a licensed U.S. pharmacy. It is not FDA-approved.

Supply has eased. The FDA lists the dulaglutide shortage as resolved, and Ozempic injection is not on its current shortage list.

Scroll the table sideways to see both columns →

For type 2 diabetes, the clinician managing your care makes the choice. The labels point to the deciding factors.

Ozempic may fit better when:

• The larger A1C and weight drop in SUSTAIN 7 matters most
• You have chronic kidney disease, where Ozempic carries a kidney-protection indication
• You have established heart disease, backed by SUSTAIN 6

Trulicity may fit better when:

• The patient is a child 10 or older with type 2 diabetes
• You prefer a single-dose pen for each weekly dose
• Your heart risk comes from risk factors rather than diagnosed heart disease, which REWIND covers

If your goal is weight management rather than diabetes care, Harbor's clinicians can review whether compounded semaglutide injections fit your history. If it is not the right fit, it is not prescribed.

Head to head, Ozempic lowered A1C and weight more than Trulicity, and the ADA ranks semaglutide higher on both. Trulicity remains well studied, with a heart-protection indication, a pediatric approval and single-dose pens.

Both carry a boxed warning for thyroid C-cell tumors seen in rats, and neither is used with a personal or family history of medullary thyroid carcinoma or MEN 2. Their most common side effects match: nausea, diarrhea, vomiting and stomach pain, mostly while the dose is rising.