Tirzepatide vs Dulaglutide: What the Research Compares

Tirzepatide and dulaglutide are both prescription medicines used in the management of type 2 diabetes, and both have been studied in large randomised clinical trials. They are separate molecules with separate development programmes, and a review of the pharmacokinetics and drug interactions of approved agents in this area described dulaglutide among the approved GLP-1 receptor agonists and tirzepatide as a dual GLP-1/GIP receptor agonist (PMID 40330819). This page summarises what published studies compared and reported. It does not rank the two medicines, and it contains no dosing information.

This page is for educational purposes only and is not medical advice; consult a licensed physician about whether any prescription medicine is appropriate, and about any question involving treatment selection, monitoring or safety.

Are the two names describing the same substance?

They are not interchangeable names for one compound. Both share the stem used for peptide based medicines, which can make the names look similar at a glance, but the published literature treats them as distinct agents with distinct receptor targets. A 2025 review of approved agents in this class grouped dulaglutide with the GLP-1 receptor agonists and described tirzepatide separately as a dual GLP-1/GIP receptor agonist (PMID 40330819). A 2024 drug review of tirzepatide in type 2 diabetes likewise characterised tirzepatide as an agent acting at both the glucose-dependent insulinotropic polypeptide receptor and the glucagon-like peptide-1 receptor (PMID 38388874).

Side by side summary

Mechanism as described in the literature

The practical difference emphasised across reviews is the number of incretin receptors engaged. Dulaglutide was described in a 2025 pharmacokinetics review as one of the approved GLP-1 receptor agonists, a group characterised by activity at the glucagon-like peptide-1 receptor (PMID 40330819). Tirzepatide was described in the same review as a dual GLP-1/GIP receptor agonist, meaning activity at the glucose-dependent insulinotropic polypeptide receptor is added (PMID 40330819). A 2024 review of tirzepatide in type 2 diabetes covered its pharmacology, clinical trial programme and tolerability profile under that dual receptor framing (PMID 38388874).

That mechanistic distinction is the reason investigators designed trials in which dulaglutide served as the active comparator rather than placebo. The researchers behind SURPASS-CVOT set out explicitly to compare tirzepatide with dulaglutide rather than with an inactive control, and the design paper framed dulaglutide as an active comparator with established cardiovascular outcome data (PMID 37758044).

Regulatory status

Both agents are available as approved prescription medicines in the jurisdictions covered by the reviews cited here. Tirzepatide was the subject of a 2024 review in the journal Drugs describing its approved use in adults with type 2 diabetes alongside its pharmacological and clinical profile (PMID 38388874). Dulaglutide appears in the 2025 pharmacokinetics and drug interaction review as one of the approved GLP-1 receptor agonists examined (PMID 40330819). Labelling, approved indications and prescribing conditions vary by country and change over time, so the current product information and a prescribing clinician remain the authoritative sources on status and use.

Head-to-head trials: what the comparisons measured

SURPASS J-mono

SURPASS J-mono was a double-blind, multicentre, randomised phase 3 trial that compared tirzepatide monotherapy with dulaglutide in Japanese patients with type 2 diabetes, and the study assessed both efficacy and safety endpoints (PMID 35914543). Because the trial enrolled a single national population and used monotherapy rather than add-on therapy, the researchers framed its findings within that specific context (PMID 35914543). The full numerical results, including glycaemic and body weight endpoints and the tolerability data, are set out in the published report.

SURPASS-CVOT

SURPASS-CVOT was designed as a cardiovascular outcomes trial comparing tirzepatide with dulaglutide on major adverse cardiovascular events in participants who had type 2 diabetes together with atherosclerotic cardiovascular disease, and the design publication described the trial structure and the baseline characteristics of the enrolled population (PMID 37758044). The results were published in 2025 under the title Cardiovascular Outcomes with Tirzepatide versus Dulaglutide in Type 2 Diabetes (PMID 41406444). Readers who want the effect estimates, confidence intervals and prespecified statistical framing should read that primary report in full rather than rely on any summary.

Kidney endpoints within SURPASS-CVOT

A separate publication reported pre-specified exploratory analyses comparing the effects of tirzepatide and dulaglutide on major kidney events among people with type 2 diabetes enrolled in SURPASS-CVOT (PMID 42114520). Exploratory analyses are generally treated as hypothesis generating rather than confirmatory, and the authors labelled these analyses as pre-specified exploratory work within the parent trial (PMID 42114520).

Evidence that sits outside the direct comparison

Not every question about these two medicines has been addressed by a head-to-head trial. Body weight is one example where much of the published work is drawn from class level reviews and from trials against other comparators. A 2021 pharmacological review examined anti-diabetic drugs and weight loss in patients with type 2 diabetes across drug classes, placing incretin based agents within that broader landscape (PMID 34302978). A 2025 analysis in JAMA Surgery compared obesity treatment with bariatric surgery against GLP-1 receptor agonists, which situates this drug class relative to a surgical alternative rather than against each other (PMID 40960852).

Pharmacokinetic questions have also been addressed at class level. The 2025 review of approved GLP-1 receptor agonists and the dual GLP-1/GIP receptor agonist compiled absorption, distribution, metabolism, elimination and drug-drug interaction data across the agents, which allows comparison of pharmacokinetic properties even where no randomised head-to-head trial examined a particular endpoint (PMID 40330819).

Adverse Events: What Studies Report

Safety data for the two agents come from both head-to-head trials and class level reviews. SURPASS J-mono assessed safety alongside efficacy in its randomised comparison of tirzepatide monotherapy with dulaglutide (PMID 35914543), and the 2024 tirzepatide review summarised the tolerability profile observed across the tirzepatide trial programme (PMID 38388874).

• Pancreatitis and gallbladder or biliary disease. A 2023 systematic review and meta-analysis examined these safety issues specifically for tirzepatide in type 2 diabetes and obesity trials (PMID 37908750).
• Cutaneous reactions. A 2024 review of the published literature catalogued rare cutaneous adverse reactions associated with GLP-1 agonists (PMID 38795152).
• Hair loss. A 2025 systematic review assessed reports of hair loss associated with GLP-1 receptor agonist use (PMID 41111833).
• Otolaryngologic complaints. A 2025 article in The Laryngoscope reviewed otolaryngologic side effects reported with GLP-1 receptor agonists (PMID 39936458).

Class level reviews of this kind describe what has been reported in the literature; they do not establish how often an event occurs with one named agent compared with another, and the reviews cited above were not designed as direct tirzepatide versus dulaglutide safety comparisons (PMID 38795152, PMID 41111833). Any individual risk question belongs with a prescribing clinician who can weigh medical history and current medicines.

What the comparison does and does not settle

1. Direct randomised comparisons exist. Unlike many drug-versus-drug questions, this one has been examined in randomised trials, including a phase 3 monotherapy trial (PMID 35914543) and a dedicated cardiovascular outcomes trial (PMID 41406444).
2. Populations were specific. SURPASS J-mono enrolled Japanese patients with type 2 diabetes (PMID 35914543), while SURPASS-CVOT enrolled participants with type 2 diabetes and established atherosclerotic cardiovascular disease (PMID 37758044). Findings in one population do not automatically transfer to another.
3. Some endpoints remain exploratory. The kidney event comparison was reported as pre-specified exploratory analysis rather than a primary confirmatory result (PMID 42114520).
4. Trial results are not treatment decisions. Comparative trial data inform clinical guidance but do not determine what is suitable for an individual, which is a matter for a licensed prescriber.

Related reading

• Tirzepatide: what the research covers
• Dulaglutide: what the research covers

References

• Efficacy and safety of tirzepatide monotherapy compared with dulaglutide in Japanese patients with type 2 diabetes (SURPASS J-mono): a double-blind, multicentre, randomised, phase 3 trial (The Lancet Diabetes & Endocrinology, 2022)
• Comparison of tirzepatide and dulaglutide on major adverse cardiovascular events in participants with type 2 diabetes and atherosclerotic cardiovascular disease: SURPASS-CVOT design and baseline characteristics (American Heart Journal, 2024)
• Cardiovascular Outcomes with Tirzepatide versus Dulaglutide in Type 2 Diabetes (The New England Journal of Medicine, 2025)
• A comparison of the effects of tirzepatide and dulaglutide on major kidney events in people with type 2 diabetes: pre-specified exploratory analyses of the SURPASS-CVOT trial (The Lancet Diabetes & Endocrinology, 2026)
• Tirzepatide: A Review in Type 2 Diabetes (Drugs, 2024)
• A Comprehensive Review on the Pharmacokinetics and Drug-Drug Interactions of Approved GLP-1 Receptor Agonists and a Dual GLP-1/GIP Receptor Agonist (Drug Design, Development and Therapy, 2025)
• Anti-diabetic drugs and weight loss in patients with type 2 diabetes (Pharmacological Research, 2021)
• Obesity Treatment With Bariatric Surgery vs GLP-1 Receptor Agonists (JAMA Surgery, 2025)
• Safety issues of tirzepatide (pancreatitis and gallbladder or biliary disease) in type 2 diabetes and obesity: a systematic review and meta-analysis (Frontiers in Endocrinology, 2023)
• Rare cutaneous adverse reactions associated with GLP-1 agonists: a review of the published literature (Archives of Dermatological Research, 2024)
• Hair Loss Associated With Glucagon-Like Peptide-1 (GLP-1) Receptor Agonist Use: A Systematic Review (Cureus, 2025)
• Otolaryngologic Side Effects of GLP-1 Receptor Agonists (The Laryngoscope, 2025)