Which is more effective for Type 2 Diabetes patients: Wegovy or Trulicity?

Both Wegovy (semaglutide 2.4 mg) and Trulicity (dulaglutide) improve blood sugar, but semaglutide generally produces greater reductions in HbA1c and body weight. NICE recommends semaglutide more widely for people needing weight-focused management.

Two GLP-1 medicines, one key difference

Wegovy and Trulicity both belong to the GLP-1 receptor agonist family of medicines. They mimic the hormone GLP-1, which reduces appetite, slows digestion, and stimulates insulin release when blood sugar rises. Despite sharing this mechanism, they are used in different ways: Wegovy is licensed in the UK for weight management, while Trulicity is licensed for type 2 diabetes.

Evidence from semaglutide

Semaglutide has been studied extensively in people with type 2 diabetes. At lower doses (up to 1 mg, branded as Ozempic), it improves HbA1c by around 1.5–1.8 percentage points and produces modest weight loss. At the higher 2.4 mg dose used in Wegovy, it goes further: in the STEP-2 trial, people with both obesity and type 2 diabetes lost nearly 10% of their body weight at 68 weeks, alongside strong improvements in blood sugar. This makes it a powerful option for those who need weight and glucose control together.

Evidence from dulaglutide

Trulicity (dulaglutide) is also effective in diabetes management. The REWIND trial showed that dulaglutide reduced HbA1c by about 1.0–1.2 percentage points and lowered cardiovascular risk in people with and without established heart disease. Weight loss with Trulicity is usually smaller, often around 2–3 kilograms on average, but it still supports better metabolic health. Its once-weekly injection schedule is similar to semaglutide’s, making it convenient for long-term use.

Head-to-head comparisons

In direct comparisons, semaglutide has generally shown greater reductions in both HbA1c and weight than dulaglutide. A trial published in The Lancet Diabetes & Endocrinology found that semaglutide 1 mg outperformed dulaglutide 1.5 mg in lowering HbA1c and supporting weight loss in people with type 2 diabetes. This evidence supports NICE’s broader recommendation for semaglutide where weight management is a key concern.

NHS guidance

NICE guidance distinguishes between the two medicines. Trulicity is recommended for people with type 2 diabetes who need better blood sugar control, particularly if they are at risk of cardiovascular disease. Wegovy (at the higher 2.4 mg dose) is approved for weight management in people with obesity, including many who also have type 2 diabetes. Clinicians may choose one over the other depending on whether the primary goal is blood sugar control or weight reduction.

Side effects and tolerability

Both drugs have similar side-effect profiles, mainly gastrointestinal issues like nausea or diarrhoea. These are usually mild to moderate and tend to settle with time. Tolerability is not typically the deciding factor between the two; instead, the choice hinges on effectiveness and the patient’s main health priorities.

Key takeaways

For people with type 2 diabetes, both Wegovy and Trulicity can improve blood sugar and support weight management. However, semaglutide at the higher Wegovy dose generally produces stronger results in both HbA1c reduction and weight loss. Trulicity remains an effective option for glucose control, particularly for those prioritising cardiovascular protection, but when weight loss is a central goal, Wegovy is often the more effective choice.