Which one controls blood sugar better?

In SUSTAIN-7, semaglutide beat dulaglutide at both dose pairs tested. Dulaglutide is now licensed up to 4.5 mg, which that trial did not test, so the result is a comparison at the doses studied rather than at current maximums.

Which is better if I have not had a heart attack but have risk factors?

That is the one population where the labels clearly differ. Trulicity’s cardiovascular indication covers multiple risk factors without established disease. Ozempic’s requires established cardiovascular disease. This is a prescribing decision, but the labels are not equivalent here.

Do either help with weight?

Both reduce weight as a secondary effect and neither is licensed for weight management. The weight-licensed brands in this class are Wegovy, Zepbound, Saxenda and Foundayo.

Trulicity vs Ozempic: The Real Licence Difference

What this page establishes

In SUSTAIN-7 at week 40, semaglutide 0.5 mg lowered HbA1c by 1.5 percentage points versus 1.1 for dulaglutide 0.75 mg, and semaglutide 1.0 mg by 1.8 versus 1.4 for dulaglutide 1.5 mg.
Trulicity is licensed to reduce major adverse cardiovascular events in adults with type 2 diabetes who have established cardiovascular disease or multiple cardiovascular risk factors. Doses: 0.75, 1.5, 3 and 4.5 mg weekly.
Ozempic is licensed to reduce major adverse cardiovascular events in adults with type 2 diabetes and established cardiovascular disease, and separately for kidney outcomes in type 2 diabetes with chronic kidney disease.

Quick answers

Which one controls blood sugar better?
In SUSTAIN-7, semaglutide beat dulaglutide at both dose pairs tested. Dulaglutide is now licensed up to 4.5 mg, which that trial did not test, so the result is a comparison at the doses studied rather than at current maximums.
Read the full answer
Which is better if I have not had a heart attack but have risk factors?
That is the one population where the labels clearly differ. Trulicity’s cardiovascular indication covers multiple risk factors without established disease.
Read the full answer
Ozempic’s requires established cardiovascular disease. This is a prescribing decision, but the labels are not equivalent here.
Do either help with weight?
Both reduce weight as a secondary effect and neither is licensed for weight management. The weight-licensed brands in this class are Wegovy, Zepbound, Saxenda and Foundayo.
Read the full answer

Trulicity is dulaglutide from Eli Lilly, Ozempic is semaglutide from Novo Nordisk, and both are once-weekly injections for type 2 diabetes. SUSTAIN-7 compared them directly, and the labels differ in a way that matters more than most brand comparisons admit.

The head-to-head

SUSTAIN-7 was an open-label phase 3b trial across 194 sites in 16 countries, comparing semaglutide against dulaglutide added to metformin at two matched dose pairs.

At week 40, semaglutide 0.5 mg lowered HbA1c 1.5 percentage points against 1.1 for dulaglutide 0.75 mg, and semaglutide 1.0 mg lowered it 1.8 points against 1.4 for dulaglutide 1.5 mg. Semaglutide arms also lost more weight and more often reached target HbA1c.

Dulaglutide has since been licensed up to 4.5 mg, above the 1.5 mg tested here.

The licence difference that gets left out

Trulicity is licensed to reduce major adverse cardiovascular events in adults with type 2 diabetes who have established cardiovascular disease or multiple cardiovascular risk factors.

Ozempic’s cardiovascular indication requires established cardiovascular disease.

That difference covers a real and large group: people with risk factors who have not yet had an event. On that population Trulicity has a licensed claim and Ozempic does not, which is the opposite direction to the head-to-head result.

Two true statements pointing different ways Semaglutide lowered HbA1c more in a direct trial. Dulaglutide has the broader licensed cardiovascular population. A comparison that reports only one of those is selling something.

What Ozempic has that Trulicity does not

A kidney indication. Ozempic is licensed to reduce the risk of sustained eGFR decline, end-stage kidney disease and cardiovascular death in type 2 diabetes with chronic kidney disease. Trulicity carries no renal outcome indication.

The evidence, one row per claim

Claim	Tier	Source
In SUSTAIN-7 at week 40, semaglutide 0.5 mg lowered HbA1c by 1.5 percentage points versus 1.1 for dulaglutide 0.75 mg, and semaglutide 1.0 mg by 1.8 versus 1.4 for dulaglutide 1.5 mg.	established	SUSTAIN-7, Lancet Diabetes & Endocrinology (Pratley et al. 2018)
Trulicity is licensed to reduce major adverse cardiovascular events in adults with type 2 diabetes who have established cardiovascular disease or multiple cardiovascular risk factors. Doses: 0.75, 1.5, 3 and 4.5 mg weekly.	established	FDA Structured Product Label, BLA125469 (via openFDA)
Ozempic is licensed to reduce major adverse cardiovascular events in adults with type 2 diabetes and established cardiovascular disease, and separately for kidney outcomes in type 2 diabetes with chronic kidney disease.	established	FDA Structured Product Label, NDA209637 (via openFDA)

Sources

Where this comes from

Researched and edited by Thomas Prommer — biohacker, performance athlete, data enthusiast and health coach.

Every number on this page traces to a named source. There are 3 sourced claims below the fold, each with the document it came from.

Sources consulted: SUSTAIN-7, FDA Structured Product Label.

Not clinically reviewed. This page was researched and written against primary regulatory and trial sources, and no clinician has checked it.

Sources last read 2026-08-23.

Keep reading

Educational content, reviewed 2026-08-23. Not medical advice, not a prescription, and not a substitute for a clinician who knows your history. Doses named here are label schedules or doses used in named trials, never a recommendation to you.

Trulicity vs Ozempic: Two Weekly Injections, One Real Licence Difference