# Is Tirzepatide Better Than Dulaglutide? One Trial Is 92% of the Answer | This GLP A network meta-analysis put tirzepatide 15 mg 2.68 kg ahead of 5 mg at week 16 | one of its four trials contributes 91.8% of the 14,348 participants it pools. Publisher: This GLP Editorial Team Canonical: https://thisglp.com/research/is-tirzepatide-better-than-dulaglutide Updated: 2026-09-17 Published: 2026-09-16 [← Research](https://thisglp.com/research) Evidence # Is Tirzepatide Better Than Dulaglutide? One Trial Is 92% of the Answer A four-trial network meta-analysis of 14,348 participants. One study supplies 13,165 of them. Every published difference is measured against tirzepatide 5 mg, not against dulaglutide. [This GLP Editorial Team](https://thisglp.com/about)September 20268 min readUpdated September 2026 A four-trial network, by participant · Nicholls 2025 — 13,165 · the other three: 1,183 between them · 91.8% of the participants come from one study. · Every difference below is measured against tirzepatide 5 mg · TZP 15 mg −2.68 kg · TZP 1 mg +4.39 kg · DULA 0.75 mg +3.10 kg **Research, not medical advice.** This GLP is independent and educational. Nothing here is a substitute for individualized care from a licensed clinician, and reading it creates no doctor–patient relationship. Talk to your own provider before starting, stopping, or changing any medication, peptide, or therapy. See our [methodology](https://thisglp.com/methodology) and [terms](https://thisglp.com/terms). ## Key takeaways - A network meta-analysis of four randomized trials, 14,348 participants in total. - One trial supplies 13,165 of them — 91.8% of the evidence. - Every published difference is measured against tirzepatide 5 mg, not against dulaglutide directly. - Tirzepatide 15 mg gave the largest weight and HbA1c reductions; nausea rose with dose. - No difference in all-cause mortality or major cardiovascular events between any treatment. On weight and HbA1c, yes, and the margin is dose-dependent. At week 16 tirzepatide 15 mg took off 2.68 kg more than tirzepatide 5 mg[\[1\]](https://thisglp.com/research/is-tirzepatide-better-than-dulaglutide#ref-1). Dulaglutide 0.75 mg took off 3.10 kg less. Four trials went into that network. One of them is almost all of it. ## Where the weight sits The headline number is 14,348 participants. Of those, 13,165 came from a single 2025 trial. The remaining three studies contributed 1,183 people between them. So this is one large trial with three small ones attached. That is not a criticism of the method. It describes what the method had to work with. It also limits a seven-node network, for the same reason [one famous trial and a whole evidence base](https://thisglp.com/research/glp1-in-children-all-eighteen-trials) give different answers. ## The results, with their reference arm Every difference is published against tirzepatide 5 mg. At week 16, tirzepatide 15 mg took off 2.68 kg more, 95% CI −4.98 to −0.38. Tirzepatide 1 mg took off 4.39 kg less and dulaglutide 0.75 mg 3.10 kg less. On HbA1c at week 24, tirzepatide 15 mg gave 0.40 points more reduction and 10 mg gave 0.23 more. Dulaglutide 1.5 mg came in at +0.67%, which reads as a worse reduction, not a better one. Drop the reference arm from any of those sentences and they stop meaning anything. The authors' own four cautions They list them plainly. Several comparisons are indirect. Many participants had not reached their maintenance dose. Several safety outcomes rest on limited event counts. Significant inconsistency was observed for the early body-weight outcomes. The dose one matters most for a reader. Comparing drugs before people reach the dose they settle on measures the titration schedule as much as the molecule. That is a different question from [what these drugs do at their maintenance doses](https://thisglp.com/research/tirzepatide-vs-semaglutide-which-works-better). ## What did not differ All-cause mortality and major cardiovascular events showed no significant difference between any treatment in the network. With 446 fewer events than you would want, that null is uninformative rather than reassuring. The authors say as much when they flag limited event counts. A pooled figure built this way carries the same problem as [two poolings of the same trials disagreeing](https://thisglp.com/research/glp1-two-meta-analyses-same-six-trials). ## The head-to-head that does exist Dulaglutide is not the only comparator with a direct trial behind it. SURPASS-2 randomized adults with type 2 diabetes to tirzepatide or semaglutide 1 mg once weekly [\[2\]](https://thisglp.com/research/is-tirzepatide-better-than-dulaglutide#ref-2). That is a head-to-head, not an indirect estimate. It is also a different question. This site reads it in [tirzepatide against semaglutide](https://thisglp.com/research/tirzepatide-vs-semaglutide-which-works-better). Nothing in it speaks to dulaglutide. ## The split the title promises The paper is titled for patients with and without established atherosclerotic cardiovascular disease. The abstract reports no such split. The full text may carry it. This page has read the abstract only. Anyone quoting this as evidence about the ASCVD subgroup is quoting something the abstract does not contain. ## What to take More tirzepatide does more, and costs more nausea. That is the finding, and it was not much in doubt. The dose-by-dose ranking is the new part. It is also the part resting on indirect comparisons and pre-maintenance doses. Read it as an ordering to test, not one to buy on. The same applies to [a pooled average almost nobody experienced](https://thisglp.com/research/glp1-weight-loss-pooled-average) is a summary rather than a forecast. ## Frequently asked Is tirzepatide better than dulaglutide? At higher doses it produced larger weight and HbA1c reductions in this network. Every comparison is against tirzepatide 5 mg rather than head to head, and several are indirect. Why does one trial matter so much here? It supplies 13,165 of the 14,348 participants, or 91.8%. The other three trials contribute 1,183 people between them, so the network is one large study with three small ones attached. Were there safety differences? No significant difference in all-cause mortality or major cardiovascular events. Gastrointestinal side effects rose with tirzepatide dose, particularly nausea at 15 mg. What does the paper say about established heart disease? Its title names that stratification, but the abstract reports no such split. Anyone citing it as evidence about that subgroup is citing something the abstract does not contain. ## Sources 1. \[1\] Hageen AW, et al. (2026). Efficacy and Safety of Tirzepatide Versus Dulaglutide in Type 2 Diabetes With or Without Established Atherosclerotic Cardiovascular Disease: A Network Meta-Analysis of Randomized Clinical Trials Endocrinology, Diabetes & Metabolism. [PMID 42706739](https://pubmed.ncbi.nlm.nih.gov/42706739/) 2. \[2\] Frías JP, Davies MJ, Rosenstock J, Pérez Manghi FC, Fernández Landó L, Bergman BK (2021). Tirzepatide versus Semaglutide Once Weekly in Patients with Type 2 Diabetes The New England Journal of Medicine. [PMID 34170647](https://pubmed.ncbi.nlm.nih.gov/34170647/) ## Where to get it ### Best GLP-1 injections Every injectable seller we can verify, with the price each one publishes and an honest read of what the trials measured. [Compare providers →](https://thisglp.com/best/compounded-semaglutide) ## More in Evidence - [ 150 minutes · Weekly activity goal · 2 days · Muscle strengthening · Adapt · Symptoms and ability ### Exercise on Ozempic: Building Strength Without Ignoring Symptoms ](https://thisglp.com/research/exercise-on-ozempic) - [ STEP 1, semaglutide 2.4 mg vs placebo, % change at 68 weeks · LDL cholesterol · −2.5% vs +1.3% · Total cholesterol · −3.3% vs +0.1% · HDL cholesterol · +5.2% vs +1.4% · Triglycerides · −21.9% vs −7.3% · Wegovy label, Table 13. Adults without diabetes. Ozempic doses are lower. ### Does Ozempic Lower Cholesterol? What the Lipid Results in the Trials Show ](https://thisglp.com/research/does-ozempic-lower-cholesterol) - [ Where the insulin reduction came from, units per day · week 4 · 13.4 total · week 26 · 21.9 · the drug itself · the weight loss · The drug’s own contribution barely moved: 11.1 then 11.4. · Everything added between weeks 4 and 26 came from weight. ### Does Semaglutide Help Type 1 Diabetes? What Two Small Trials Found ](https://thisglp.com/research/semaglutide-in-type-1-diabetes)