Dulaglutide vs Semaglutide: Trulicity vs Ozempic Compared

Head‑to‑head efficacy: SUSTAIN‑7

SUSTAIN‑7 randomised adults with type 2 diabetes inadequately controlled on metformin to semaglutide 0.5 mg vs dulaglutide 0.75 mg, and semaglutide 1.0 mg vs dulaglutide 1.5 mg, once weekly for 40 weeks (Lancet 2018) [1].

• HbA1c change from baseline:
  • Semaglutide 0.5 mg: −1.5 percentage points vs dulaglutide 0.75 mg: −1.1 pp (ETD −0.40; p<0.0001).
  • Semaglutide 1.0 mg: −1.8 pp vs dulaglutide 1.5 mg: −1.4 pp (ETD −0.41; p<0.0001).
• Body weight change:
  • Semaglutide 0.5 mg: −4.6 kg vs dulaglutide 0.75 mg: −2.3 kg (ETD −2.26 kg; p<0.0001).
  • Semaglutide 1.0 mg: −6.5 kg vs dulaglutide 1.5 mg: −3.0 kg (ETD −3.55 kg; p<0.0001).

Interpretation: For glycaemic control and weight in type 2 diabetes, semaglutide generally produces larger reductions than dulaglutide at the studied doses.

See dosing/titration schedules • Check costs and PBS info • Get personalised advice

Cardiovascular outcomes at a glance

• Semaglutide: SUSTAIN‑6 showed a 26% relative risk reduction in 3‑point MACE vs placebo (HR 0.74; 95% CI 0.58–0.95) over 2 years [2].
• Dulaglutide: REWIND showed a 12% MACE reduction vs placebo (HR 0.88; 95% CI 0.79–0.99) over a median 5.4 years, including many patients without established CVD [3].

Both agents have cardiometabolic benefits beyond glucose lowering, with differences in study design and populations worth discussing with your clinician.

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Dosing and titration: how they’re started and stepped

Semaglutide (Ozempic) — type 2 diabetes

• 0.25 mg once weekly for 4 weeks (initiation; not for glycaemic control).
• Increase to 0.5 mg once weekly for ≥4 weeks.
• May increase to 1 mg once weekly if needed after ≥4 weeks at 0.5 mg.
• Some patients may be escalated to 2 mg once weekly if additional control is required (prescriber‑directed).

Semaglutide (Wegovy) — obesity

• 0.25 mg weekly × 4 weeks → 0.5 mg × 4 weeks → 1.0 mg × 4 weeks → 1.7 mg × 4 weeks → 2.4 mg weekly (maintenance), as tolerated [4].

Dulaglutide (Trulicity) — type 2 diabetes

• Start 0.75 mg once weekly for ≥4 weeks.
• Increase to 1.5 mg once weekly if needed.
• Further options: 3.0 mg and 4.5 mg once weekly, with step‑ups typically at ≥4‑week intervals, based on response and tolerability.

Titration pace may be slower if patients experience nausea or other GI effects. Never change doses without medical advice.

Semaglutide dosage guide • Trulicity prescription steps • Ask about a safe titration plan

Weight loss beyond diabetes

• Semaglutide 2.4 mg (Wegovy) achieved ~14.9% mean weight loss at 68 weeks in STEP‑1 vs 2.4% with lifestyle alone (NEJM 2021) [4].
• Dulaglutide is not approved for obesity; in diabetes trials it produces modest average weight loss (often ~1–3 kg depending on dose and baseline characteristics).

For patients prioritising weight loss, semaglutide at obesity‑dose levels has the strongest evidence among the two.

Semaglutide for weight loss explained • Find out which option fits your goals

Side effects, precautions and safety notes

• Common: nausea, vomiting, diarrhoea/constipation, abdominal pain, decreased appetite. Usually improve with slower titration.
• GI events: SUSTAIN‑7 reported GI adverse events more frequently with semaglutide than dulaglutide across dose pairs [1].
• Serious/rare: pancreatitis, gallbladder disease, acute kidney injury (often secondary to dehydration), diabetic retinopathy complications (noted in SUSTAIN‑6 with rapid HbA1c lowering [2]).
• Contraindications: personal/family history of medullary thyroid carcinoma (MTC) or MEN2; hypersensitivity to drug components.
• Use with caution: history of pancreatitis; severe GI disease; dose‑adjust other glucose‑lowering agents (e.g., sulfonylureas/insulin) to reduce hypoglycaemia risk.

Ozempic side effects • Trulicity side effects • Report side effects and get help

Usability and pens: what day‑to‑day looks like

• Once‑weekly injection for both. Choose a consistent day; may switch if the gap is ≥48 hours (product‑specific directions apply).
• Pre‑filled pens with fine needles; training on injection technique reduces bruising and nausea perception. Rotate sites (abdomen, thigh, upper arm).
• Storage: refrigerate unopened pens; in‑use storage allowances vary by brand—check the consumer medicine information.

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Costs and PBS status in Australia

Indicative pricing only — pharmacies may vary and supply constraints can affect availability.

• Ozempic (semaglutide) for type 2 diabetes:
  • PBS: Listed for eligible T2D criteria. Patient co‑payment typically around standard PBS levels (general vs concessional). Date context: 2025–2026 policy settings.
  • Private: When not PBS‑subsidised (e.g., for weight loss), expect roughly AUD $130–$160 per pen depending on dose and pharmacy.
• Trulicity (dulaglutide) for type 2 diabetes:
  • PBS: Listed for eligible T2D criteria; co‑payment at PBS rates.
  • Private: Approximately AUD $130–$170 per pen if purchased privately.
• Wegovy (semaglutide 2.4 mg) for obesity:
  • PBS: Not PBS‑listed for obesity.
  • Private: Commonly AUD $190–$350 per pen depending on strength and pharmacy.
• Rybelsus (oral semaglutide):
  • PBS status: As of our last verified check (October 2024), Rybelsus was not PBS‑listed in Australia for any indication. Listings can change; verify via the PBS website.
  • Private: Frequently in the AUD $120–$160 range per monthly pack, varying by strength and pharmacy.

Ozempic cost details • Trulicity cost details • Wegovy cost details • Rybelsus cost details

Check your likely out‑of‑pocket costs

Which is better for whom?

• If weight loss is a major goal: semaglutide is favoured (more weight loss in SUSTAIN‑7; dedicated obesity‑dose data from STEP trials).
• If slower titration/tolerability is a concern: some patients prefer dulaglutide’s GI profile; others tolerate semaglutide well with cautious step‑ups.
• If cardiovascular risk reduction is a priority: both have positive outcome trials; individualise based on comorbidities, background therapy and access.
• If oral therapy is desired: oral semaglutide (Rybelsus) is an option for T2D (TGA‑approved); note the PBS/price differences and strict dosing instructions (empty stomach).

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Frequently asked questions

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References

1. SUSTAIN‑7: Pratley RE, Aroda VR, et al. Semaglutide versus dulaglutide once weekly in patients with type 2 diabetes (SUSTAIN‑7). Lancet. 2018;391(10140):2417‑2426.
2. SUSTAIN‑6: Marso SP, Bain SC, et al. Semaglutide and cardiovascular outcomes in patients with type 2 diabetes. N Engl J Med. 2016;375:1834‑1844.
3. REWIND: Gerstein HC, Colhoun HM, et al. Dulaglutide and cardiovascular outcomes in type 2 diabetes (REWIND). Lancet. 2019;394(10193):121‑130.
4. STEP‑1: Wilding JPH, Batterham RL, et al. Once‑weekly semaglutide in adults with overweight or obesity. N Engl J Med. 2021;384:989‑1002.