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Best Peptides for Type 2 Diabetes: What the Evidence Shows
Which peptide drugs are FDA-approved for type 2 diabetes, and what trials found on blood sugar, heart and kidneys. Not every one protects the heart.
The short answer
Several peptide drugs are FDA-approved for type 2 diabetes, each for the uses on its label. Dosing should come from the label and your clinician.
Among the peptides we reviewed, semaglutide, liraglutide and tirzepatide have the strongest evidence for type 2 diabetes: all three are FDA-approved for it and have large randomized trials. Semaglutide also has a kidney outcome trial. Other approved drugs, including dulaglutide, are covered below but not ranked, because we have no stand-alone review of them yet.
Not every GLP-1 drug has shown fewer heart attacks, strokes or cardiovascular deaths: some trials found a reduction and others found no significant difference.
Compounded and ‘research use’ versions are not FDA-approved.
Whether any of these is right for you is a decision for a prescriber.
On this page
Type 2 diabetes is one of the few goals where several peptide drugs are FDA-approved and tested in large trials. They are not interchangeable: they differ on heart outcomes, kidney outcomes and who they are approved for.
The ranking, by strength of evidence
| Peptide | U.S. status | Strongest evidence |
|---|---|---|
| 1. Semaglutide | Human trials | |
| 2. Liraglutide | Human trials | |
| 3. Tirzepatide | Human trials |
How do we decide what is “best”?
We rank by the evidence that a peptide helps with this goal: the type of study first, then its quality and its result. A rank is not a recommendation. For type 2 diabetes we looked at three kinds of result: blood sugar (HbA1c), heart events and kidney outcomes. See how we rate peptides.
The three ranked drugs are all backed by randomized trials, so the order comes from the quality and results of those trials for type 2 diabetes outcomes. Semaglutide comes first because it has placebo-controlled trials showing fewer heart events and a kidney outcome trial. Liraglutide comes next, with a placebo-controlled heart trial. Tirzepatide lowered HbA1c more than semaglutide 1 mg in SURPASS-2, an open-label trial funded by its maker, but its heart trial compared it with another drug, not placebo. The order says nothing about how far each lowers blood sugar.
This guide is about type 2 diabetes. For weight loss, which is a different goal, see our guide to peptides for weight loss.
Which peptide drugs are approved for type 2 diabetes?
Brand names are used here only to identify approved products. Each is approved for the uses on its own label.
| Active ingredient | Product | Type 2 diabetes uses on the label | Label |
|---|---|---|---|
| Semaglutide (injection) | Ozempic | Blood sugar control in adults; fewer major cardiovascular events in adults with type 2 diabetes and established cardiovascular disease; less kidney decline, kidney failure and cardiovascular death in type 2 diabetes with chronic kidney disease | Ozempic |
| Semaglutide (tablets) | Rybelsus and Ozempic tablets | Blood sugar control in adults; fewer major cardiovascular events in high-risk type 2 diabetes. The label says the two tablets are “not substitutable on a mg-to-mg basis” | Rybelsus |
| Tirzepatide | Mounjaro | Blood sugar control in adults and children 10 and older; fewer major cardiovascular events in adults with type 2 diabetes at high cardiovascular risk (added Aug. 27, 2026) | Mounjaro |
| Liraglutide | Victoza, and generics | Blood sugar control in people 10 and older; fewer major cardiovascular events in adults with type 2 diabetes and established cardiovascular disease | Victoza |
| Dulaglutide | Trulicity | Blood sugar control in adults and children 10 and older; fewer major cardiovascular events in type 2 diabetes with established cardiovascular disease or multiple risk factors | Trulicity |
| Lixisenatide and insulin glargine | Soliqua 100/33 | Blood sugar control in adults. The label says using it with any other GLP-1 product is not recommended | Soliqua |
| Liraglutide and insulin degludec | Xultophy 100/3.6 | Approved for type 2 diabetes; we did not review its label | Not reviewed |
Three notes on this table:
- Children. Mounjaro, Victoza and Trulicity are approved from age 10. Ozempic’s label does not include a pediatric indication.
- Some products are listed as discontinued. As of Nov. 5, 2026, Drugs@FDA lists exenatide (Byetta and both Bydureon products) and pramlintide (Symlin) as discontinued. Byetta’s label and SymlinPen’s label remain in DailyMed, and SymlinPen’s carries a boxed warning for severe low blood sugar. Drugs@FDA lists lixisenatide (Adlyxin) as a prescription product, but DailyMed has no label for it, and we did not verify whether it is sold. We do not say any of these is available.
- Insulin is also a peptide. Many insulin products are FDA-approved. We did not review individual insulin labels and do not compare them here.
For the semaglutide products, see our semaglutide guide and Wegovy vs Ozempic. For tirzepatide, see our tirzepatide guide and Zepbound vs Mounjaro. For liraglutide, see our liraglutide guide and semaglutide vs liraglutide.
What do the trials show on blood sugar?
We read HbA1c results for semaglutide and tirzepatide only. We did not review the blood sugar trials for liraglutide or dulaglutide for this guide.
| Drug | Trial | Design | Result |
|---|---|---|---|
| Semaglutide (injection) | Monotherapy, 30 weeks, 388 people | Randomized, double-blind | HbA1c 1.2 and 1.4 points lower than placebo, per the Ozempic label |
| Semaglutide vs sitagliptin, exenatide or insulin glargine | 30 or 56 weeks | Randomized; two were open-label | HbA1c 0.3 to 0.8 points lower than the active comparator, per the Ozempic label |
| Tirzepatide vs semaglutide 1 mg | SURPASS-2, 1,879 people, 40 weeks | Randomized, open-label, funded by Lilly | HbA1c fell 2.01 to 2.30 points with tirzepatide (three dose arms) vs 1.86 with semaglutide |
| Tirzepatide in young people | SURPASS-PEDS, 99 people aged 10 and older, 30 weeks | Randomized, double-blind | HbA1c fell 1.9 and 2.2 points vs 0.2 with placebo, per the Mounjaro label |
SURPASS-2 is the direct comparison between those two drugs. It was open-label and funded by the manufacturer of tirzepatide, and the semaglutide arm used a lower dose than the one used for weight management. Results in separate trials can’t be lined up.
Which drugs have shown fewer heart events?
Not all of them have. The outcome in these trials is “MACE”: cardiovascular death, non-fatal heart attack or non-fatal stroke.
Not every GLP-1 drug has shown fewer heart attacks, strokes or cardiovascular deaths: some trials found a reduction and others found no significant difference.
| Trial | Drug and comparison | Who | Result |
|---|---|---|---|
| LEADER | Liraglutide vs placebo | 9,340 with type 2 diabetes at high cardiovascular risk | 13.0% vs 14.9%; hazard ratio 0.87 (95% CI 0.78–0.97) |
| SUSTAIN 6 | Semaglutide (injection) vs placebo | 3,297; 83% with cardiovascular or kidney disease | 6.6% vs 8.9%; hazard ratio 0.74 (0.58–0.95) |
| SOUL | Semaglutide (tablets) vs placebo | 9,650 with type 2 diabetes and atherosclerotic cardiovascular disease, chronic kidney disease or both; median 49.5 months | 12.0% vs 13.8%; hazard ratio 0.86 (0.77–0.96). The confirmatory secondary outcomes showed no significant difference |
| REWIND | Dulaglutide vs placebo | 9,901 people 50 and older with prior cardiovascular disease or risk factors; median 5.4 years | 12.0% vs 13.4%; hazard ratio 0.88 (0.79–0.99). Death from any cause: no significant difference (0.90; 0.80–1.01) |
| SURPASS-CVOT | Tirzepatide vs dulaglutide | 13,299 with type 2 diabetes and cardiovascular disease | Hazard ratio 0.92 (95.3% CI 0.83–1.01): non-inferior, not shown to be superior |
| EXSCEL | Exenatide (weekly) vs placebo | 14,752; 73% with prior cardiovascular disease | 11.4% vs 12.2%; hazard ratio 0.91 (0.83–1.00): non-inferior, no significant reduction |
| ELIXA | Lixisenatide vs placebo | 6,068 with a recent acute coronary syndrome | 13.4% vs 13.2%; hazard ratio 1.02 (0.89–1.17): neutral |
Five things to keep in mind:
- Hazard ratios from different trials cannot be ranked against each other. The people, follow-up and comparison groups differ.
- Tirzepatide’s heart trial compared it with dulaglutide, not placebo. Non-inferior means it was not worse by a pre-set margin. It was not shown to be better.
- SUSTAIN 6’s primary analysis tested whether semaglutide was no worse than placebo (a non-inferiority margin of 1.3), though the Ozempic label says the drug “significantly reduced the occurrence of MACE.”
- REWIND included people without prior heart disease. Most of the other trials enrolled people who already had it, so their results apply to that group.
- Every trial in this table was funded by the maker of the drug it tested; LEADER was also funded by the National Institutes of Health.
Which drug has kidney evidence?
In our review, semaglutide (injection). In FLOW, people with type 2 diabetes and chronic kidney disease had a lower risk of a combined outcome of serious kidney events and cardiovascular death (hazard ratio 0.76, 95% CI 0.66–0.88). That trial is the basis of Ozempic’s kidney indication. We reviewed no kidney outcome trial for the other drugs in this guide.
What are the risks?
- Boxed warning. Ozempic, Rybelsus, Mounjaro, Victoza and Trulicity carry a warning for thyroid C-cell tumors seen in rodents. All are contraindicated with a personal or family history of medullary thyroid carcinoma or MEN 2.
- Low blood sugar. Several labels warn that the risk rises when these drugs are combined with insulin or drugs that raise insulin.
- Eye complications. Several labels warn about diabetic retinopathy complications with rapid improvement in blood sugar.
- Supply. FDA’s shortage list showed no entries for dulaglutide, exenatide or tirzepatide on Nov. 5, 2026. Semaglutide had only some Rybelsus tablet strengths listed as “to be discontinued.” Victoza was listed with limited availability. See our liraglutide guide.
What is still in trials?
None of these is approved for type 2 diabetes.
| Drug | Status | Data in type 2 diabetes |
|---|---|---|
| Orforglipron | Approved only for weight reduction (Foundayo, April 1, 2026). Not a peptide. Not approved for type 2 diabetes | ACHIEVE-1: 559 people, 40 weeks; HbA1c fell 1.24 to 1.48 points vs 0.41 with placebo |
| Retatrutide | Not approved | TRANSCEND-T2D-1: 537 people with type 2 diabetes managed with diet and exercise alone, 40 weeks; HbA1c 0.88 to 1.12 points lower than placebo |
| CagriSema | Not approved as of Nov. 5, 2026 | REIMAGINE 2: 2,713 people taking metformin; HbA1c fell 1.91 vs 1.75 with semaglutide alone (difference 0.16 points) |
See our retatrutide guide. A trial result is not an approval, and none of these should be described as an approved diabetes treatment.
What about BPC-157, MOTS-c and other “research” peptides?
We found no clinical trials of BPC-157 for diabetes. A search of Europe PMC on Nov. 5, 2026 found no publication indexed as a clinical trial of BPC-157, and none in diabetes; what exists on glucose and diabetes is animal studies and reviews. See our BPC-157 guide.
MOTS-c has no published human-use data, according to FDA. FDA said it identified no studies or human exposure data (FDA). The reports of lower insulin resistance are in mice. We did not count a ClinicalTrials.gov record of MOTS-c in prediabetes, because we could not confirm that it describes a real study.
Neither is FDA-approved. Under an interim policy published Oct. 30, 2026, and open for public comment, HHS said it does not intend to take enforcement action against state-licensed pharmacies, federal facilities or licensed physicians that compound BPC-157 or MOTS-c under section 503A, as long as all of the policy’s conditions are met, including limits on form and route. This is enforcement discretion, not approval, and it is not evidence that either peptide helps with diabetes. FDA does not review compounded drugs for safety, effectiveness or quality before they are marketed. HHS may revisit the policy. Read the notice.
What about compounded and “research” semaglutide or tirzepatide?
Compounded and ‘research use’ versions are not FDA-approved. FDA says products of this kind are “of unknown quality and may be harmful”, and the HHS policy above does not cover semaglutide or tirzepatide. See what FDA says about compounded GLP-1 drugs and what “research use only” means.
Which claims are not supported?
- “All GLP-1 drugs protect the heart.” Exenatide (EXSCEL) and lixisenatide (ELIXA) did not significantly reduce heart events, and tirzepatide was non-inferior to dulaglutide, not superior.
- “The trial hazard ratios show which drug protects the heart most.” Different people, comparators and follow-up.
- “Exenatide or Adlyxin are available.” Drugs@FDA lists the exenatide products as discontinued, and we could not confirm Adlyxin is sold.
- “Rybelsus and Ozempic tablets can be swapped milligram for milligram.” The label says they cannot.
- “BPC-157 or MOTS-c treat diabetes.” We found no human trials of either in diabetes.
- “Orforglipron, retatrutide or CagriSema are approved for diabetes.” They are not.
What should you ask your doctor?
- Do I need a drug that also lowers heart or kidney risk, and which one has that on its label?
- Do I have a personal or family history of medullary thyroid carcinoma or MEN 2?
- Can this be combined with my insulin or sulfonylurea without raising the risk of low blood sugar?
- Do I have diabetic retinopathy?
- What is the plan if my product is hard to find?
- Is the product FDA-approved or compounded, and who makes it?
We do not give doses, and we do not recommend products or sellers.
Frequently asked questions
What is the best peptide for type 2 diabetes?
Among the peptides we reviewed, semaglutide, liraglutide and tirzepatide have the strongest evidence, and all three are FDA-approved for type 2 diabetes. Which one fits you is a decision for a prescriber.
Do all GLP-1 drugs protect the heart?
No. Not every GLP-1 drug has shown fewer heart attacks, strokes or cardiovascular deaths: some trials found a reduction and others found no significant difference.
Is Ozempic approved for children with type 2 diabetes?
Ozempic’s label does not include a pediatric indication. Mounjaro, Victoza and Trulicity are approved from age 10.
Is exenatide still available?
Drugs@FDA lists Byetta and both Bydureon products as discontinued as of Nov. 5, 2026.
Can BPC-157 help with diabetes?
We found no clinical trials of BPC-157 for diabetes.
Is compounded semaglutide the same as Ozempic?
No. Compounded and ‘research use’ versions are not FDA-approved.
How did we rank them?
We rank by the type of evidence first, then its quality and its result. If no peptide has good evidence for a goal, we say so.
- Human trialsControlled trials in people, published in a journal, that tested a clinical outcome and showed a benefit. The strongest kind of evidence we report.
- Limited human dataSmall, short or inconclusive human studies, including observational studies, uncontrolled trials and controlled trials that did not show a clinical benefit.
- Animal studiesResults in animals often don’t carry over to people.
- Lab studiesCells or tissue in a dish. An early signal, not an answer.
From Best Peptides Today
Sources we checked
- Ozempic prescribing information (DailyMed, version effective June 2026)FDA. Accessed .
- Rybelsus prescribing information (DailyMed, rev. 01/2026)FDA. Accessed .
- Mounjaro prescribing information (DailyMed, rev. 08/2026)FDA. Accessed .
- Mounjaro prescribing information (FDA label PDF, SURPASS-PEDS)FDA. Accessed .
- Victoza prescribing information (DailyMed, rev. 10/2025)FDA. Accessed .
- Trulicity prescribing information (DailyMed, version effective June 2026)FDA. Accessed .
- Byetta prescribing information (DailyMed, rev. 09/2025)FDA. Accessed .
- Soliqua 100/33 prescribing information (DailyMed, rev. 03/2026)FDA. Accessed .
- SymlinPen prescribing information (DailyMed, rev. 12/2019)FDA. Accessed .
- Drugs@FDA (searched Nov. 5, 2026: exenatide and pramlintide products listed as discontinued; lixisenatide product listed without a DailyMed label)FDA. Accessed .
- Drugs@FDA record, NDA 220934 (orforglipron, Foundayo)FDA. Accessed .
- FDA drug shortages listFDA. Accessed .
- LEADER trial (PubMed)PubMed. Accessed .
- SUSTAIN 6 trial (PubMed)PubMed. Accessed .
- SOUL trial (PubMed)PubMed. Accessed .
- REWIND trial (PubMed)PubMed. Accessed .
- SURPASS-CVOT trial (PubMed)PubMed. Accessed .
- EXSCEL trial (PubMed)PubMed. Accessed .
- ELIXA trial (PubMed)PubMed. Accessed .
- FLOW trial (PubMed)PubMed. Accessed .
- SURPASS-2 trial: tirzepatide vs semaglutide (PubMed)PubMed. Accessed .
- ACHIEVE-1 trial of orforglipron (PubMed)PubMed. Accessed .
- TRANSCEND-T2D-1 trial of retatrutide (PubMed)PubMed. Accessed .
- REIMAGINE 2 trial of CagriSema (PubMed)PubMed. Accessed .
- FDA: FDA's concerns with unapproved GLP-1 drugs used for weight lossFDA. Accessed .
- FDA presentations to the Pharmacy Compounding Advisory Committee on MOTS-c (July 23, 2026)FDA. Accessed .
- Federal Register: HHS enforcement discretion policy on 503A peptide compounding (Oct. 30, 2026)Other. Accessed .
- Europe PMC search: BPC-157 clinical trials (searched Nov. 5, 2026)Other. Accessed .
Written and maintained by the Best Peptides For Editorial Team. How we rate evidence.