Tuesday, March 21, 2023

Ozempic vs Trulicity: Which is more effective?

HealthOzempic vs Trulicity: Which is more effective?

Trulicity and Ozempic are medications that help type-2 diabetics control their blood sugar levels. Classified as “glucagon-like peptide-1 (GLP-1) agonists,” the drugs are similar in many ways. Both medications are injected once weekly with a prefilled pen into fatty tissue in the abdomen, thigh, or the upper arm. Moreover, neither medication contains insulin.

One difference is in their blood-sugar controlling ingredients. Trulicity contains the drug dulaglutide while Ozempic contains semaglutide, however, both drugs are classified as GLP-1 agonists. 

In a non-diabetic, GLP-1 is naturally occurring to activate communication across the brain, gut, pancreas, stomach, liver, and the heart. Such a smooth running multi-communication system recognizes the need for nourishment and responds by releasing insulin to balance blood sugar levels after a person eats. 

GLP-1 communication is unclear for type-2 diabetics. Like being out of cellular range and needing to make a call, signal strength is inadequate. 

Trulicity was released for US consumers’ use in 2014. Trulicity is often prescribed for Type-2 diabetics at risk for suffering heart attack or stroke (cardiovascular events). 

Ozempic, unavailable until 2018, exhibited the power to lower blood glucose even with a lower dose than Trulicity. Ozempic’s popularity skyrocketed after a sixth trial demonstrated cardiovascular superiority over a placebo, although Ozempic was unequal to Trulicity’s cardiovascular efficacy.

In order to determine which drug is more effective, let’s delve a little deeper.

Indications and Limitations

Both drugs are proven to lower blood sugar in type-2 diabetic patients, and both are indicated for use in addition to diet and exercise to improve glycemic control in type-2 diabetic adults. Both can reduce the risk of major adverse cardiovascular events (cardiovascular death, non-fatal myocardial infarction, or non-fatal stroke) in adults. Neither drug, however, is indicated for type-1 diabetic patients.

Because type-2 diabetics do produce some insulin, these medications promote the release of insulin when it is most needed, usually right after mealtimes. According to the FDA, type-2 diabetic patients cannot take two or more of any GLP-1 medication concurrently. Consequently, physicians must choose which medication to prescribe. Type-2 diabetics can, however, take other type-2 diabetes medications while using a GLP-1, a subject patients can discuss with their doctors.

How the Medications Work?

Ozempic’s semaglutide and Trulicity’s dulaglutide both bind to GLP-1 receptors. When needed, GLP-1 receptors then stimulate insulin release from the pancreas. Basically, the drugs mimic the communicative actions of GLP-1, helping regulate blood glucose levels. First, GLP-1 binds to, and then activates the body’s GLP-1 receptor, stimulating insulin secretion to lower the secretion of glucagon (a small protein cell linked to blood pressure) whenever blood glucose levels are high. This link to blood pressure is important; because type-2 diabetics typically have high blood pressure; GLP-1 appears able to lower it. Both medications also reduce the amount of sugar released by the liver, thus reducing the amount of food leaving the stomach. This helps prevent blood sugar spikes. With lower blood sugar levels, patients’ A1C levels are also reduced.

Safety Considerations

Pancreatitis, inflammation of the pancreas, occurred in clinical studies of Trulicity, with 1.4 cases out of every 1,000 people taking it for 1 year. In Ozempic trials, results indicated pancreatitis as also an ‘uncommon’ side effect. Pancreatitis could cause scar tissue with resulting damage to pancreatic function over time. The over-time result of pancreatitis can be developing type-1 diabetes. 

Pregnant women shouldn’t take either medication unless their physician determines that benefits will likely outweigh the risks of uncontrolled diabetes. Those risks include preeclampsia, preterm delivery, and spontaneous abortions.

Common side effects with both drugs

  • diarrhea
  • loss of appetite
  • nausea
  • vomiting
  • upset stomach

Uncommon side effects with both drugs

  • feeling pressure in the stomach
  • vision problems
  • acute kidney injury *
  • serious allergies
  • hypoglycemia *

• Acute Kidney Injury:  Indications of acute kidney injury and worsening of chronic renal failure can occur, which may require hemodialysis, in patients treated with GLP-1 receptor agonists. 

  • Hypoglycemia: Patients using Ozempic combined with an insulin secretagogue (eg, sulfonylurea) may experience a higher risk of hypoglycemia, even severe hypoglycemia.

Ozempic: Uncommon Side Effects

  • acid or sour stomach
  • pain in the stomach, side, or abdomen, possibly radiating to the back
  • belching
  • excess air or gas in stomach
  • heartburn
  • passing gas
  • stomach discomfort, swelling, or tenderness 
  • anxiety
  • bloating
  • blurred vision
  • chills
  • cold sweats
  • confusion
  • constipation   
  • cool, pale skin
  • cough
  • darkened urine
  • depression
  • upset stomach
  • seizures
  • skin rash
  • slurred speech
  • tightness in the chest
  • trouble breathing
  • unusual tiredness or weakness
  • large, hive-like swelling on the face, eyelids, lips, tongue, throat, hands, legs, feet, or sex organs

Trulicity: Uncommon side effects

  • changes in vision
  • low blood sugar
  • severe stomach problems
  • severe allergic reactions

Regarding “uncommon side effects,” a comparison is difficult. This is because

Ozempic’s longer list includes generalized descriptors that appear similar to Trulicity’s specific side effects. Such description choices might be explained by differences in marketing techniques. For example, Trulicity’s “severe stomach problems” is generally noted by Ozempic, but as ten less consequential ailments.

A1C, Weight Loss, and More  

Testing a patient’s A1C provides a good measure of diabetes management. The blood test provides an average percentage of red blood cells coated with sugar over time, usually 3 months. The ADA recommends a target below 7.0%; the American Association of Clinical Endocrinologists recommends a target below 6.5%. Therefore, lowering type-2 AIC is considered a positive result for most type-2 diabetic patients.

A picture containing text

Description automatically generated

Studies determined that over 3 months, Trulicity (1.5mg. dose) reduced A1C by 1.4%. Ozempic (1.0mg. dose) reduced A1C by 1.8%. Both reductions were remarkably positive, but the smaller dose of Ozempic yields better results. 

Weight loss study results were equally positive. Ozempic patients lost an average 12.8 lbs. with a 1mg. dose. Trulicity’s 1.5mg. dose achieved an average loss of 6.2 pounds. Note that even with a reduced dosage over the trial, Ozempic achieved better results. It should be noted, however, that this clinical trial, called SUSTAIN 7, was performed by the makers of Ozempic.

In September 2020, Trulicity received FDA approval to offer higher dosages. This might have changed the GLP-1 landscape. However, even with increased dosages, average A1C reduction was lower (1.5% vs Ozempic’s 1.8%) than Ozempic’s efficacy. Trulicity’s average weight loss increased only to 10.4 pounds vs Ozempic’s 12.8 pounds. 

A picture containing timeline

Description automatically generated

Ozempic’s increased strength to 2mg. received FDA approval in early 2022. The approval, after another clinical trial, yielded lower risk of cardiovascular events like heart attack, stroke and death in type-2 patients with known heart disease. Moreover, further analysis of data from the trial found improved weight loss across body/mass indicator (BMI) subgroups over Trulicity. And Ozempic achieved better results for cardiovascular events. Also in 2022, study results pointed to a link between GLP-1 and hypertension (high blood pressure), information that can help researchers improve these drugs’ effectiveness.

Diagram, timeline

Description automatically generated


A comparison of the (GLP-1) agonist drugs’ effects is illuminating. For the most part, the drugs work similarly, and undesirable side effects appear similar, though Ozempic’s lack of clarity is questionable, but likely due to marketing choices or due to study priorities. 

Desired effects point to Ozempic as the most effective. Even with comparably lower doses, Ozempic patients may achieve lower A1C and BMI scores, and they may also benefit from greater weight reduction and less chance of cardiovascular events. 

The most effective drug choice for all patients should be made in consultation with their physician. Each patient’s primary physician and/or diabetes specialist (endocrinologist) will take all aspects of each patient’s personal information into account, to include medical history, present conditions and predispositions toward conditions, as well as each patient’s medication regimen. Informed patients and trusted physicians are powerful allies in determining the most effective choices for patients.

More From Author