Which is better, dulaglutide or mazdutide?
On the head-to-head evidence mazdutide is superior for both glucose and weight (DREAMS-2 and a phase 2 trial). But dulaglutide has a completed cardiovascular outcomes trial, an FDA label that includes children 10 and older, and lawful US access, while mazdutide is approved only by China's regulator and cannot be compounded or sold in the United States. Where mazdutide is approved, the trial evidence favors it; in the United States, dulaglutide is the one that can be prescribed. [1] [2] [3] [4] [5] [6]
How do dulaglutide and mazdutide compare?
| Dimension | Dulaglutide | Mazdutide |
|---|---|---|
| Head-to-head evidence [1] [2] | Dulaglutide 1.5 mg weekly: HbA1c 1.35 points and weight 2.7% lower at 20 weeks in the phase 2 trial; reference arm in DREAMS-2. | Mazdutide: HbA1c 1.41 to 1.67 points and weight up to 7.1% lower at 20 weeks in phase 2; in DREAMS-2, HbA1c 0.24 (4 mg) and 0.30 (6 mg) points and weight 3.8% and 5.8% lower than dulaglutide at 28 weeks. |
| Note: Both trials enrolled Chinese adults with type 2 diabetes; the phase 2 trial had 250 participants and DREAMS-2 had 731. | ||
| Mechanism [4] [7] | Selective GLP-1 receptor agonist (Fc fusion protein). | Dual GLP-1 and glucagon receptor agonist (oxyntomodulin analog). |
| Cardiovascular outcomes [3] [4] [7] | REWIND: major adverse cardiovascular events hazard ratio 0.88 over a median 5.4 years in 9,901 adults; labeled for cardiovascular risk reduction in type 2 diabetes. | No cardiovascular outcomes trial has reported. |
| Side effects [1] [2] [4] | Nausea, diarrhea, vomiting, and abdominal pain; fewer gastrointestinal events than mazdutide in DREAMS-2. | Diarrhea 36%, decreased appetite 29%, nausea 23%, and vomiting 14% in the phase 2 trial; gastrointestinal events more frequent than with dulaglutide in DREAMS-2. |
| Weight management indication [4] [7] [8] | None; approved for type 2 diabetes and cardiovascular risk reduction only. | Approved in China for chronic weight management (June 2025): 14.0% weight loss at 6 mg over 48 weeks in GLORY-1. |
| Regulatory status [4] [5] [6] | FDA approved (Trulicity, September 2014), including children 10 and older. | Approved in China for type 2 diabetes (September 2025) and weight management; not FDA approved and not eligible for US compounding. |
| WADA status [9] | Not on the WADA Prohibited List. | Not named on the list; with approval in China, section S0 may not apply. Confirm with the relevant anti-doping organization. |
| Dosing [1] [4] [7] | Once weekly injection, 0.75 mg escalated up to 4.5 mg. | Once weekly injection; 4 or 6 mg in the phase 3 diabetes and obesity trials. |
Evidence grade and regulatory status
Pulled from each peptide’s own record, so it stays in step with the peptide pages.
| Attribute | Dulaglutide | Mazdutide |
|---|---|---|
| Class | GLP-1 receptor agonist (two modified GLP-1 analogs fused to a human IgG4 Fc fragment, once weekly) | Dual agonist of the GLP-1 and glucagon receptors (oxyntomodulin analog, acylated, once weekly) |
| 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. | GLP-1/glucagon dual agonist with 14% weight loss at 48 weeks in a Chinese phase 3 trial and 18% at 16 mg in a US phase 2; not FDA approved. |
| Evidence | Evidence: Human RCT evidence | Evidence: Human RCT evidence |
| FDA status | Regulatory: FDA approved | Regulatory: Not eligible for compounding |
| 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. | Not FDA approved as of the last verification date. Because mazdutide is not a component of an FDA approved drug, has no USP monograph, and is not on the 503A bulks list, it cannot lawfully be compounded or dispensed in the United States, and any product sold as mazdutide in the US is an unapproved drug. Its development and registration have centered on China, where the national drug regulator approved it for chronic weight management in adults (June 2025) and for type 2 diabetes (September 2025); those approvals do not make it legal to sell or compound in the US. |
| WADA | WADA: Not WADA prohibited | WADA: WADA status unclear |
| Routes | Subcutaneous injection once weekly (single dose pen) | Subcutaneous injection once weekly |
| 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. | Not available through licensed channels in the United States. Products sold as research chemicals are not lawful for human use and are not verified for identity or purity. |
| Last verified |
Has dulaglutide been tested directly against mazdutide?
| Study | Design and population | Outcome | Grade |
|---|---|---|---|
| Mazdutide versus dulaglutide in Chinese adults with type 2 diabetes (DREAMS-2)2026 PMID 41407860 | Randomized phase 3 trial, 28 weeksn = 731 Chinese adults with type 2 diabetes on background oral antidiabetic drugs | HbA1c treatment difference minus 0.24 (4 mg) and minus 0.30 (6 mg) points versus dulaglutide 1.5 mg; weight difference minus 3.78% and minus 5.76%; more gastrointestinal adverse events with mazdutide | Evidence: Human RCT evidence |
| Efficacy and safety of mazdutide in Chinese patients with type 2 diabetes: a randomized, double-blind, placebo-controlled phase 2 trial2024 PMID 37943529 | Randomized, double blind, placebo controlled phase 2 trial with open label dulaglutide, 20 weeksn = 250 Chinese adults with type 2 diabetes on diet and exercise or metformin | HbA1c change minus 1.41 to minus 1.67 points with mazdutide versus minus 1.35 with dulaglutide 1.5 mg; weight change up to minus 7.1% versus minus 2.7% | Evidence: Human RCT evidence |
What do dulaglutide and mazdutide cost?
| Dimension | Dulaglutide | Mazdutide |
|---|---|---|
| Typical cost | $389 to $1,007 per month | Not available through licensed channels in the United States. Products sold as research chemicals are not lawful for human use and are not verified for identity or purity. |
| Price detail | Dulaglutide price by channel | Price index in progress |
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 mazdutide better than dulaglutide for type 2 diabetes?
In DREAMS-2, both mazdutide doses were superior to dulaglutide 1.5 mg, lowering HbA1c 0.24 to 0.30 points more and weight 3.8% to 5.8% more at 28 weeks, with more gastrointestinal side effects. [1]
Does dulaglutide help with weight loss?
Modestly. It lowered weight by 2.7% at 20 weeks in the mazdutide phase 2 trial and has no weight management indication in the United States. [2] [4]
Can I switch from dulaglutide to mazdutide in the US?
No. Mazdutide is not FDA approved and cannot be lawfully compounded or sold in the United States; it is approved only in China. [5] [6]
Which one has heart protection data?
Only dulaglutide: REWIND showed a 12% relative reduction in major adverse cardiovascular events, and the US label includes that indication. No mazdutide outcomes trial has reported. [3] [4]
Conditions studied
Sources
Numbered citations above point to these primary sources. PubMed entries link to the indexed abstract.
- [1]Guo L et al. Mazdutide versus dulaglutide in Chinese adults with type 2 diabetes. Nature 2026 (DREAMS-2)PubMed 41407860, 2026
- [2]Zhang B et al. Efficacy and safety of mazdutide in Chinese patients with type 2 diabetes: a randomized, double-blind, placebo-controlled phase 2 trial. Diabetes Care 2024PubMed 37943529, 2024
- [3]Gerstein HC et al. Dulaglutide and cardiovascular outcomes in type 2 diabetes (REWIND). Lancet 2019PubMed 31189511, 2019
- [4]FDA prescribing information for Trulicity (dulaglutide) injection, via DailyMedFDA
- [5]Manufacturer press release: China's drug regulator (NMPA) approves mazdutide for glycemic control in type 2 diabetes (September 19, 2025), accessed 2026-09-222025
- [6]FDA: Bulk drug substances used in compounding under section 503A of the FD&C ActFDA
- [7]Ji L et al. Once-weekly mazdutide in Chinese adults with obesity or overweight. N Engl J Med 2025 (GLORY-1)PubMed 40421736, 2025
- [8]Manufacturer press release: China's drug regulator (NMPA) approves mazdutide for chronic weight management (June 27, 2025), accessed 2026-09-222025
- [9]WADA Prohibited List (section S0 covers substances not approved by any government health authority)WADA
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