Comparative Gastrointestinal Safety of Dulaglutide, Semaglutide, and Tirzepatide in Adults With Type 2 Diabetes
Authors' conclusion
These findings suggest that dulaglutide, semaglutide, and tirzepatide have similar gastrointestinal safety profiles in adults with T2D. This study provides clinicians with evidence to weigh the benefits and risks of these medications.
Study context
- Population
- Adults with T2D initiating dulaglutide, subcutaneous semaglutide or tirzepatide, 1 January 2019–30 August 2024, routine clinical practicematched cohorts
- Exposure
- Dulaglutide vs subcutaneous semaglutide vs tirzepatide
- Outcome
- Composite of:
- Acute pancreatitis
- Biliary disease
- Bowel obstruction
- Gastroparesis
- Severe constipation
Methodological details1:1 propensity score matched within each comparison, 3 pairwise comparisons
- 1:1 propensity score matched within each comparison
- 3 pairwise comparisons
Main finding
As reported in the abstract
Severe GI adverse events (composite)
Hazard ratio (95% CI)
Semaglutidevs Dulaglutide65 238 matched pairs
0.96(0.87–1.06)
Tirzepatidevs Dulaglutide20 893 matched pairs
0.96(0.77–1.20)
Tirzepatidevs Semaglutide46 620 matched pairs
1.07(0.90–1.26)
Observational data: associations, not effects.
Original publication
Comparative Gastrointestinal Safety of Dulaglutide, Semaglutide, and Tirzepatide in Adults With Type 2 Diabetes. Ann Intern Med. Published 4 November 2025. doi:10.
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