Comparison of Two Major Antidiabetic Medications

For diabetics, choosing the right medication can be an important part of their daily life and healthcare routine. Type 2 diabetics have an array of antidiabetic medications available to them and therefore, should consider their best options for treatment.

Two popular antidiabetic medications are Trulicity and Ozempic. Both of these medications are given by prescription only and both categorized under the drug class of glucagon-like peptide 1 (GLP-1) receptor agonists.

These two medications both have pros and cons to their use in treating patients with type 2 diabetes.

Trulicity (generic name: dulaglutide)

What is it

Trulicity is the brand name of the drug dulaglutide, which is a GLP-1 receptor agonist. An agonist means that the medication mimics the actions of a GLP-1 receptor.

GLP-1 is one of the main receptor types in the body that triggers insulin secretion. For someone with type 2 diabetes, the aid of a GLP-1 receptor agonist like dulaglutide, can trigger insulin that otherwise would not have been released. This lowers a person’s blood sugar levels and helps aid in glycemic control.

Furthermore, GLP-1 also reduces glucagon in the body. Glucagon is a hormone produced in the liver to keep sugar in the blood (this leads to high blood sugars). So by lowering glucagon, dulaglutide (or Trulicity) also helps lower blood sugar.

Essentially, GLP-1 is like a big flashing warning sign that says “your blood sugar is too high! You need to produce insulin to control it and you need to stop producing glucagon.”

When a person has type 2 diabetes, their GLP-1 receptors do not act effectively due to insulin resistance and frequent high blood sugars built up over time. To make up for a loss in bodily GLP-1 function, synthetic Trulicity (dulaglutide) mimics the GLP-1 receptor.

What it does

The main functions of Trulicity are: to control high blood sugar in diabetic clients (glycemic control) and to prevent clot formation that could lead to life-threatening events (stroke, heart attack, embolism). An off-label function that Trulicity might also contribute to is weight loss. Trulicity can delay gastric emptying, which sometimes reduces appetite, leading to weight loss.

Pros

  1. Trulicity reduces the risk of stroke & heart attack by lowering blood sugar.
  2. Sometimes it leads to weight loss because it slows digestion & creates a “full” feeling. However, this is an off-label use not approved by the FDA. It may be a secondary benefit but is rarely prescribed as a primary function of Trulicity.
  3. Trulicity only has to be taken once weekly via injection.

Cons

  1. Trulicity is injected subcutaneously through a small needle prick under the skin, so it might not be right for people who are afraid of needles.
  2. In some clinical trials, Trulicity (dulaglutide) appears to be less effective than Ozempic (semaglutide) at lowering blood sugars and diabetic A1C levels.
  3. In some cases, Trulicity can have more side effects than Ozempic.

Common side effects of Trulicity:

Some common side effects can occur as a result of Trulicity use. These side effects can typically be controlled or minimized with proper treatment from a healthcare provider. The side effects of Trulicity include nausea, vomiting, diarrhea, constipation, decreased appetite, indigestion, flatulence, belching, feelings of fullness, acid reflux (GERD), heartburn, frequent bowel movements, fatigue and malaise, feeling bloated, weakness, and lack of energy. One, none, or multiple of these side effects can occur with Trulicity. Inform your healthcare provider if you develop these side effects and cannot find relief.

Rare complications of Trulicity:

More severe but rare complications that can occur include: angioedema, allergic reactions, kidney disease, kidney failure, heart rhythm issues (such as AV heart blocks), and hypoglycemia (from taking too high or frequent doses). Notify your healthcare provider immediately if you develop one of these complications.

Price

While medication costs always vary, Trulicity’s price per unit is about $467. Medicare Part D and private insurance plans typically cover the cost of Trulicity. However, if a person is paying out of pocket, a Trulicity prescription can be nearly $1,009 per month (4 single-dose pens).

Discounts may be found online to lower the out-of-pocket cost of Trulicity to $300 when you order through BuyCanadianInsulin.com.

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Ozempic (generic name: semaglutide)

What is it

Ozempic also mimics a GLP-1 receptor agonist to lower blood sugar. The medication works very similarly to Trulicity, and just has a slightly different chemical formula. The main ingredient in Ozempic is semaglutide, which is slightly different from dulaglutide.

Semaglutide is a GLP-1 receptor agonist that utilizes the same mechanism of action as dulaglutide. However, some clinical trials have found that semaglutide (Ozempic) is more effective than dulaglutide at controlling blood sugar.

Ozempic also helps reduce the production of glucagon in the liver, which additionally lowers blood sugar levels.

What it does

Ozempic is used to control high blood sugar in diabetic clients (glycemic control) and to prevent clot formation that could lead to life-threatening events (stroke, heart attack, embolism). Ozempic can also be used off-label to help promote weight loss, in some cases, due to delayed gastric emptying caused by the drug.

Pros

  1. Ozempic is also only injected once per week and is typically self-injected by the diabetic client, providing more autonomy.
  2. The actual dosage of semaglutide in Ozempic is lower than Trulicity, which could make the medication cheaper and less invasive.
  3. Ozempic seems to have less side effects than Trulicity, which can make the medication more comfortable and pleasant for use.

Cons

  1. Ozempic also still requires a needle stick so people who are afraid of needles might need to build their tolerance and courage.
  2. Currently, studies on whether Ozempic leads to weight loss are limited so the medication has less documented evidence of weight loss than Trulicity.
  3. Adverse effects of Ozempic drug interactions can be more severe than Trulicity drug interactions.

Common side effects of Ozempic:

There are some common non-life-threatening side effects that can occur when taking Ozempic. If they occur, you can consult your doctor about ways to minimize or treat them. The side effects include nausea, vomiting, diarrhea, constipation, intermittent abdominal pain or discomfort, dehydration, vision changes (if someone has diabetic retinopathy), and hypoglycemia (from taking too high or frequent doses of Ozempic).

Rare complications of Ozempic:

Just like Trulicity, Ozempic has the possibility of an allergic reaction or angioedema complication. This is emergent and requires a person to go to the emergency department for evaluation. Other rare complications include constant abdominal pain and abdominal pain that radiates to the back. This might be a sign of pancreatitis and a person should report to the emergency department, too, if the pain continues to be persistent and unresolved.

Price

The unit cost for Ozempic is about $627, which is more than Trulicity’s cost per unit, however, Ozempic requires less units in each dose. Medicare Part D and private insurance plans typically cover the cost of Ozempic.

Out-of-pocket costs of Ozempic are approximately $1,205/month, which is less than half the cost of Trulicity. Through BuyCanadianInsulin.com, patients can order Ozempic for only $290.

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Drug Interactions with Trulicity/Ozempic

Ozempic and Trulicity can interact with both oral medications and insulin, leading to hypoglycemia or other reactions.

Trulicity interacts with furosemide, hydrochlorothiazide, glimepiride, glipizide, and levothyroxine in a moderate way. The most concerning results of such drug interactions include gastroparesis, pancreatitis, thyroid carcinoma, renal dysfunction, and hypoglycemia.

Ozempic interacts with many of the same medications as Trulicity, including furosemide, hydrochlorothiazide, and levothyroxine. Ozempic also interacts moderately with Tresiba (insulin degludec). The main adverse reactions of such interactions include hypoglycemia, pancreatitis, retinopathy, gastrointestinal symptoms, suicidal ideation, and even thyroid cancer.

For questions about medications you’ve been on, speak to your doctor at the time of prescription.

Foods are not known to interact with Trulicity and Ozempic, however, alcohol will interact with both of these two medications. Consuming large amounts of alcohol while on these medications can lead to dangerously low blood sugar, or hypoglycemia. Such a reaction can cause a person to feel shaky, weak, sweaty and clammy, lightheaded, confused, and anxious. Prolonged hypoglycemia can lead to coma or even be fatal. Contact your doctor if you suspect a hypoglycemic reaction.

Drug Warnings

The effect of both Trulicity and Ozempic on pregnancy is still unclear, so it is recommended to discuss intention to get pregnant or current pregnancy with your doctor. It is also unclear whether Trulicity or Ozempic can be taken during breastfeeding. Sometimes healthcare providers will prescribe insulin to control type 2 diabetes for pregnant women, especially in the labor and delivery department, but a healthcare provider might still recommend Trulicity or Ozempic for outpatient type 2 diabetes treatment for postpartum women.

If you or anyone in your family has a history of thyroid cancer or thyroid tumors, you should inform your healthcare provider immediately, as Ozempic and Trulicity have been shown to increase risk of thyroid tumors in animal studies. Signs of thyroid carcinoma would include a new lump in your neck, difficulty swallowing, hoarse voice and sore throat, and shortness of breath. Call your healthcare provider immediately if you notice any of these signs.

Conclusion

While Trulicity and Ozempic share many similarities in their mechanism of action, route of injection, effectiveness, side effects, and use, there are slight differences between the two medications. Speak to your healthcare provider about which medication (if either) is right for you to use when treating type 2 diabetes mellitus.

Your pharmacist or healthcare provider might also be able to assist you in finding a medication that is right to control high blood sugars and A1C levels.

For more information on treating type 2 diabetes, please read other articles on our website.