Trulicity vs. Victoza vs. Bydureon — Which is Better for Diabetes?

a doctor's prescription pad
Dr. Sharon Orrange
Dr. Orrange is an Associate Professor of Clinical Medicine in the Division of Geriatric, Hospitalist and General Internal Medicine at the Keck School of Medicine of USC.
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Trulicity, Victoza, and Bydureon all belong to a newer class of non-insulin diabetes medications known as GLP-1 (glucagon-like peptide-1) receptor agonists that improve blood sugar control and may lead to weight loss. They were each approved by the FDA in the last decade, and increase how much insulin the pancreas makes in response to high glucose levels.

Which drug is the most effective?

Trulicity (dulaglutide), approved in 2014, is the newest out of these three drugs. Clinical studies show that Trulicity is just as effective at lowering Hgb-A1C as Bydureon (exenatide) and Victoza (liraglutide). It’s even equivalent to Januvia (sitagliptin) and metformin (Glucophage), other commonly prescribed diabetes drugs, in terms of lowering A1C levels.

Which drug is the easiest to use?

Trulicity is an injection under the skin given once a week at a dose of 0.75 mg. The dose may be increased to 1.5 mg once weekly if you need better control of your sugars. Trulicity is available in a ready-to-use pen device with an automatic injector.

Victoza is also an injection given under the skin. Unlike Trulicity and Bydureon, it needs to be administered once a day instead of once a week. Dosing starts at 0.6 mg per day for one week, and then it’s increased to 1.2 mg. 1.8 mg per day can be used if you need additional blood sugar control. Victoza comes in a pre-filled, multi-dose pen that delivers doses of 0.6 mg, 1.2 mg, or 1.8 mg.

Bydureon is also an injection given under the skin, and like Trulicity, it’s administered once a week. Compared to Trulicity and Victoza, Bydureon can be more complicated to use. Bydureon comes either as a pre-filled pen or as a single-dose tray with a vial, syringe, needle, and connector that you have to learn how to assemble. If you get the tray, you’ll also have to learn how to mix the medication and fill a syringe for your weekly injection.

Which drug has the least side effects?

Trulicity, Victoza, and Bydureon have similar side effects because they belong to the same GLP-1 receptor agonist drug class. The most common side effects of GLP-1 receptor agonists are nausea, vomiting, and diarrhea.

Importantly, GLP-1 receptor agonists are not recommended for people with a history of thyroid cancer because they can increase the risk for thyroid tumors, including cancer. These drugs can also increase the risk for inflammation of the pancreas and kidney failure, so they’re not recommended in people who have had pancreatitis or have kidney problems. In few cases, they can also lead to gallstones, allergic reactions, and injection-site reactions like itching, pain, and swelling.

GLP-1 receptor agonists will not work if sugars are low. Therefore, unlike with insulin, there is almost no risk of low sugar levels, or hypoglycemia with these medication. The risk for hypoglycemia is higher is you’re taking another medication like insulin that is known to lower blood sugar.

Which drug causes the most weight loss?

The American Diabetes Association recommends weight loss as an important goal for overweight people with type 2 diabetes. Trulicity, Bydureon, and Victoza are not weight loss drugs, but some patients have lost weight while taking them. (Some patients have also gained weight while taking these medicines.)

Trulicity may cause a modest weight loss of about six pounds over 26 weeks. In two studies, patients on Bydureon lost an average of three pounds after 28 weeks. And clinical studies of Victoza ranging from 26 to 52 weeks long showed that Victoza could help with weight loss. When Victoza was taken with metformin, patients lost an average of about six pounds.

Dr O.

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