Dulaglutide vs exenatide: evidence, cost, and legality

Which is better, dulaglutide or exenatide?

AWARD-1 showed both dulaglutide doses were superior to twice daily exenatide for HbA1c at 26 and 52 weeks, dulaglutide needs one injection a week instead of fourteen, and it has a proven cardiovascular benefit. Exenatide's once weekly form was safe but not superior to placebo for cardiovascular events in EXSCEL, and both branded exenatide products were discontinued in October 2024. [1] [2] [3] [4]

How do dulaglutide and exenatide compare?

Dulaglutide and Exenatide compared by dimension
Dimension	DulaglutideFavored	Exenatide
Head-to-head evidence [1]	Dulaglutide 1.5 mg and 0.75 mg weekly lowered HbA1c by 1.51 and 1.30 points at 26 weeks in AWARD-1, both superior to exenatide at 26 and 52 weeks.	Exenatide 10 micrograms twice daily lowered HbA1c by 0.99 points at 26 weeks (placebo 0.46).
Note: AWARD-1 added treatment to metformin plus pioglitazone. Total hypoglycemia was lower with dulaglutide 1.5 mg than with exenatide.
Cardiovascular outcomes [2] [3] [5]	REWIND: major adverse cardiovascular events hazard ratio 0.88 (95% CI 0.79 to 0.99) over a median 5.4 years in 9,901 adults; labeled for cardiovascular risk reduction.	EXSCEL: hazard ratio 0.91 (95% CI 0.83 to 1.00) in 14,752 adults; noninferior but not superior to placebo.
Dosing frequency [5] [6] [7] [8]	Once weekly injection, 0.75 mg up to 4.5 mg.	Twice daily injection before meals (5 then 10 micrograms), or 2 mg once weekly as the extended release form.
Side effects [1] [5] [7] [8]	Nausea, vomiting, and diarrhea, mostly mild to moderate and transient in AWARD-1; boxed warning for thyroid C-cell tumors.	Nausea is the most common effect; the extended release form causes injection site nodules and carries the thyroid C-cell boxed warning, which the twice daily form does not.
Market availability [4] [5]	Marketed as Trulicity, including for children 10 and older.	The manufacturer notified FDA that Byetta was discontinued on October 25, 2024 and Bydureon BCise on October 28, 2024; health plans moved members to other GLP-1 drugs.
Regulatory status [4] [5] [7] [10] [11]	FDA approved (September 2014). FDA listed dulaglutide injection as in shortage in its October 2024 to February 2025 GLP-1 updates, with all presentations available; it is not listed in FDA's shortage database as of September 27, 2026.	FDA approved (Byetta 2005, Bydureon 2012) but no longer marketed. Never part of the shortage compounding era.
WADA status [9]	Not on the WADA Prohibited List.	Not on the WADA Prohibited List.

Evidence grade and regulatory status

Pulled from each peptide’s own record, so it stays in step with the peptide pages.

Dulaglutide and Exenatide: grade, status, and cost
Attribute	Dulaglutide	Exenatide
Class	GLP-1 receptor agonist (two modified GLP-1 analogs fused to a human IgG4 Fc fragment, once weekly)	GLP-1 receptor agonist (synthetic 39 amino acid exendin-4, originally isolated from Gila monster saliva; twice daily and once weekly extended release forms)
What it is	FDA approved weekly GLP-1 drug for type 2 diabetes that cut heart attacks, strokes, and heart deaths by 12% over 5.4 years in REWIND; not for weight loss.	The first GLP-1 drug, FDA approved in 2005; lowers HbA1c (3 month blood sugar) 0.8 to 1.9 points with 2 to 4 kg weight loss; no proven heart benefit.
Evidence	Evidence: Human RCT evidence	Evidence: Human RCT evidence
FDA status	Regulatory: FDA approved	Regulatory: FDA approved
Compounding	FDA approved product (Trulicity, September 2014; 3.0 mg and 4.5 mg doses added in 2020; pediatric indication in 2022; cardiovascular risk reduction indication based on REWIND). Because dulaglutide is a component of an approved drug, 503A pharmacies may compound it only for a documented patient specific need and may not produce essentially a copy of the commercial product. Dulaglutide is not available in a bulk powder form suitable for compounding. FDA listed dulaglutide injection as in shortage in its October 2024 to February 2025 GLP-1 updates, with all presentations available; it is not listed in FDA's shortage database as of September 27, 2026.	FDA approved products (Byetta April 2005, Bydureon January 2012, Bydureon BCise October 2017) for type 2 diabetes. Because exenatide is a component of approved drugs, 503A pharmacies may compound it only for a documented patient specific need and may not produce essentially a copy of a marketed product. Exenatide was not part of the semaglutide and tirzepatide shortage era. Product presentations have narrowed over time; check DailyMed for what is currently marketed.
WADA	WADA: Not WADA prohibited	WADA: Not WADA prohibited
Routes	Subcutaneous injection once weekly (single dose pen)	Subcutaneous injection twice daily before meals (immediate release pen), Subcutaneous injection once weekly (extended release microsphere autoinjector)
Typical cost	Trulicity list price is 1,006.93 USD per month for four pens at any strength; the manufacturer's self-pay pharmacy sells it from 389 USD per month. With commercial insurance and a manufacturer savings card a covered prescription is often 25 USD per month. Medicare Part D covers it for type 2 diabetes. No generic is available as of the last verified date.	Byetta and Bydureon BCise list at roughly 800 to 1,000 USD per month. With commercial insurance a covered prescription is often 25 to 100 USD per month, and Medicare Part D covers exenatide for type 2 diabetes. No generic is available as of the last verified date, and many formularies now prefer newer GLP-1 agonists.
Last verified	Sep 27, 2026	Sep 27, 2026

Has dulaglutide been tested directly against exenatide?

Direct comparisons of Dulaglutide and Exenatide
Study	Design and population	Outcome	Grade
Efficacy and safety of dulaglutide added onto pioglitazone and metformin versus exenatide in type 2 diabetes in a randomized controlled trial (AWARD-1)2014 PMID 24879836	Randomized, placebo and active controlled phase 3 trial, 52 weeks (primary end point 26 weeks)Adults with type 2 diabetes on metformin and pioglitazone, mean HbA1c 8.1%	HbA1c change minus 1.51 (dulaglutide 1.5 mg), minus 1.30 (0.75 mg), minus 0.99 (exenatide 10 micrograms twice daily), minus 0.46 (placebo) at 26 weeks; both dulaglutide doses superior to exenatide at 26 and 52 weeks	Evidence: Human RCT evidence

What do dulaglutide and exenatide cost?

Typical cost of Dulaglutide and Exenatide
Dimension	Dulaglutide	Exenatide
Typical cost	$389 to $1,007 per month	Byetta and Bydureon BCise list at roughly 800 to 1,000 USD per month. With commercial insurance a covered prescription is often 25 to 100 USD per month, and Medicare Part D covers exenatide for type 2 diabetes. No generic is available as of the last verified date, and many formularies now prefer newer GLP-1 agonists.
Price detail	Dulaglutide price by channel	Exenatide price by channel

Where a price index exists, the range is the cash price per month across branded, compounded, and telehealth channels, without insurance. The cost pages give each channel separately with its sources. Otherwise the typical cost from the peptide record is shown. Legal access depends on your state: see peptide legality by state.

Frequently asked questions

Is dulaglutide better than exenatide?

Yes on the direct evidence. In AWARD-1 both dulaglutide doses lowered HbA1c more than twice daily exenatide (1.51 and 1.30 versus 0.99 points at 26 weeks), with less hypoglycemia at 1.5 mg. [1]

Can I still get exenatide?

Branded twice daily and once weekly exenatide were discontinued in the United States in October 2024, and health plans switched members to other GLP-1 drugs such as dulaglutide, liraglutide, or semaglutide. [4]

Do both lower cardiovascular risk?

Only dulaglutide has shown it: REWIND found a 12% relative reduction in major cardiovascular events. Once weekly exenatide was safe in EXSCEL but the reduction (hazard ratio 0.91) did not reach statistical superiority. [2] [3]

How often is each injected?

Dulaglutide is injected once weekly. Exenatide was injected twice daily before meals as the immediate release form, or once weekly as the extended release form. [5] [7] [8]

Conditions studied

Sources

Numbered citations above point to these primary sources. PubMed entries link to the indexed abstract.

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Dulaglutide vs exenatide

The short answer