By Lew Kizer — 2026-10-28 — Health & Nutrition
The short answer
On Oct. 28, 2026, Eli Lilly reported that retatrutide, an investigational weekly injection, beat Ozempic 2 mg in the 80-week Phase 3 TRANSCEND-T2D-2 trial of 1,298 adults with type 2 diabetes. A1C fell 2.2 points on both retatrutide doses vs. 1.8 on Ozempic. Weight fell 19.5% (9 mg) and 20.9% (12 mg) vs. 9.4% on Ozempic. These are company topline numbers, not yet peer reviewed, and retatrutide is not approved anywhere.
Key facts
- Trial: TRANSCEND-T2D-2 (NCT06260722), Phase 3, randomized, open-label, 80 weeks.
- 1,298 adults with type 2 diabetes on metformin, with or without an SGLT2 inhibitor; baseline A1C 7.0% to 10.5%.
- Randomized 2:2:1 to retatrutide 9 mg, retatrutide 12 mg or Ozempic (semaglutide) 2 mg, Ozempic's highest approved dose.
- A1C change from an 8.3% average: -2.2 points (9 mg), -2.2 points (12 mg), -1.8 points (Ozempic).
- Weight change from 225.8 lbs average: -19.5% or 44.3 lbs (9 mg), -20.9% or 47.4 lbs (12 mg), -9.4% or 20.9 lbs (Ozempic).
- Stopped because of side effects: 4.8% (9 mg) and 7.9% (12 mg) vs. 2.7% (Ozempic).
- All figures are the efficacy estimand. Full results have not been peer reviewed. Retatrutide is investigational.
KINGSPORT, Tenn., Oct. 28, 2026 — Eli Lilly said Wednesday morning that its experimental weekly shot retatrutide lowered blood sugar more than Ozempic and produced more than twice the weight loss in the first head-to-head Phase 3 trial between the two, in adults with type 2 diabetes.
This article reports medical news and is not medical advice. Talk with your prescriber before you start, stop or change any medicine.
The numbers
| 80 weeks | Retatrutide 9 mg | Retatrutide 12 mg | Ozempic 2 mg |
|---|---|---|---|
| A1C change (from 8.3%) | -2.2 points | -2.2 points | -1.8 points |
| Weight change (from 225.8 lbs) | -19.5% (44.3 lbs) | -20.9% (47.4 lbs) | -9.4% (20.9 lbs) |
| Stopped for side effects | 4.8% | 7.9% | 2.7% |
The trial, TRANSCEND-T2D-2, randomized 1,298 adults whose diabetes was not controlled on metformin, with or without an SGLT2 inhibitor. Lilly says both retatrutide doses beat Ozempic on A1C and weight. Retatrutide also improved non-HDL cholesterol, triglycerides and systolic blood pressure more than Ozempic, according to the company release.
Read the fine print
- Topline, not peer reviewed. Lilly says full results will be presented at a medical meeting and published in a journal. No dates were given.
- Efficacy estimand only. The numbers estimate what happens if people stay on the medicine. Results that count everyone who started are usually smaller.
- Open-label. Participants knew which drug they were on.
- Different population. People with type 2 diabetes tend to lose less weight on these drugs. That is why these figures are lower than the up to 25% average loss seen in the earlier TRIUMPH-1 obesity trial.
- Not approved. Retatrutide is investigational everywhere. Products sold online as "retatrutide" are not approved medicines.
Side effects
Stomach-related effects led the list. Diarrhea was reported in 28.3% and 32.7% of people on the two retatrutide doses vs. 26.4% on Ozempic; nausea in 21.2% and 23.8% vs. 21.3%. Constipation was actually less common on retatrutide (14.2% and 13.1% vs. 19.8%). Dysesthesia, an unusual skin sensation, was more frequent on retatrutide (4.8% and 6.5% vs. 2.7%). Lilly says most events were mild to moderate.
What it means for the dinner plate
Losing 40-plus pounds over a year and a half on a reduced appetite raises the same food questions every GLP-1 user faces: getting enough protein to protect muscle, eating smaller portions that still fill you up, and keeping blood sugar steady. Our GLP-1 meal planning guide covers protein-first eating, and the 7-day GLP-1 meal plan shows what a week can look like. If you are on semaglutide today, see our Wegovy meal plan. For blood-sugar-minded meals, see diabetic-friendly meal delivery.
“You don't have to figure out the macros. You don't have to wonder if the portions are right. We've already done that work. All you have to do is eat.” — Lew Kizer, Founder, SmashMeals
Commentary, not medical advice
The SmashMeals perspective
Bigger numbers on a scale mean a smaller appetite at the table, and that makes every bite carry more weight. Whatever medicine people end up on, the food question stays the same: enough protein, sensible portions and meals you can trust. That is the part we cook for. The medicine belongs to you and your doctor.
Frequently asked questions
Is retatrutide approved?
No. Retatrutide is investigational and is not approved by the FDA or any other regulator. Lilly has not announced a submission date in its Oct. 28 release.
How did retatrutide compare with Ozempic?
In TRANSCEND-T2D-2, A1C fell 2.2 points on both retatrutide doses vs. 1.8 on Ozempic 2 mg. Weight fell 19.5% on 9 mg and 20.9% on 12 mg vs. 9.4% on Ozempic over 80 weeks. These are company-reported efficacy-estimand results.
Why is the weight loss lower than in earlier retatrutide trials?
This trial enrolled people with type 2 diabetes, who typically lose less weight on these medicines than people with obesity alone. The earlier TRIUMPH-1 trial enrolled adults with obesity and no diabetes.
What does 'efficacy estimand' mean?
It estimates the effect if people kept taking the medicine as intended. Results that count everyone, including people who stopped, are usually somewhat smaller. Lilly's release reports only the efficacy estimand.
What were the side effects?
Mostly stomach-related: diarrhea, nausea, constipation and vomiting, generally mild to moderate. Dysesthesia, an unusual skin sensation, was more common on retatrutide. More people stopped retatrutide because of side effects than stopped Ozempic.
Sources and credits
Follow the original sources for context and verification. A reference is not an endorsement of SmashMeals.
- Lilly's retatrutide delivered greater A1C reduction and more than double the weight loss of Ozempic's highest approved dose in head-to-head trial (opens in a new tab)
Eli Lilly and Company (PR Newswire)
Why it matters: The primary topline release: design, results, side effects and discontinuation rates.
- Lilly's triple agonist, retatrutide, delivered powerful weight loss in pivotal Phase 3 obesity trial (opens in a new tab)
Eli Lilly and Company
Why it matters: Earlier Phase 3 results in adults with obesity, for comparison.
- ClinicalTrials.gov: NCT06260722 (TRANSCEND-T2D-2) (opens in a new tab)
U.S. National Library of Medicine
Why it matters: The registered trial design.