TRANSCEND-T2D-2 Results: Retatrutide vs Ozempic Head to Head

Retatrutide beat Ozempic on blood sugar and on weight in its first head-to-head trial. In TRANSCEND T2D 2 (Lilly writes it TRANSCEND-T2D-2), 1,298 adults with type 2 diabetes took retatrutide 9 mg, retatrutide 12 mg or Ozempic 2 mg once a week for 80 weeks. A1C fell 2.2 points on both retatrutide doses against 1.8 on Ozempic, and weight fell 19.5% and 20.9% against 9.4%. Lilly released those topline numbers on October 28, 2026; the full paper isn't out.

Everything below comes from Lilly's October 28 release and the trial's ClinicalTrials.gov record, which we pulled on October 31, 2026. All results are Lilly's efficacy estimand, counted as if everyone had stayed on their drug. This page covers the trial itself; if you're weighing the two drugs, retatrutide vs Ozempic does that comparison, and retatrutide Phase 3 results puts this trial next to the other five that have reported.

How TRANSCEND-T2D-2 was set up

The registry calls it "Effect of Retatrutide Compared With Semaglutide", and Lilly's study code is J1I-MC-GZBZ. It's the second of three registrational trials in Lilly's TRANSCEND-T2D diabetes program and the first Phase 3 trial to put retatrutide against another incretin drug.

If the 2:2:1 split held exactly, that's about 519 people on each retatrutide dose and about 260 on Ozempic. That's our arithmetic; Lilly hasn't published arm sizes.

The registry's exclusions shape who these results apply to. People being treated, or due to be treated, for diabetic eye disease were left out, as were people with kidney function below an eGFR of 45, any past pancreatitis, a personal or family history of medullary thyroid cancer or MEN 2, a lifetime suicide attempt, past or planned weight-loss surgery, or a heart attack, stroke or heart failure admission in the previous 90 days. Entry required metformin with or without an SGLT2 inhibitor, so the trial didn't enroll people on a stable insulin or sulfonylurea regimen as their background treatment (our reading of the criteria).

Two design choices matter for reading the numbers. The trial was open label, so everyone knew which drug they had; A1C and weight are measured, not reported, which makes them harder to sway than side-effect counts. And the efficacy estimand assumes everyone stayed on their study drug for 80 weeks, with dose pauses allowed, without adding another glucose-lowering drug for more than 14 days.

TRANSCEND T2D 2 results for A1C and weight

People started at an average A1C of 8.3% and 102.4 kg (225.8 lb), with a BMI of 36.8. By week 80, A1C was down 2.2 points on both retatrutide doses and 1.8 on Ozempic. People on retatrutide lost 20.1 kg (44.3 lb) on 9 mg and 21.5 kg (47.4 lb) on 12 mg, against 9.5 kg (20.9 lb) on Ozempic.

The chart gives each arm's average. The table gives the gap between each dose and Ozempic, and how firmly the trial's statistics back it. "Controlled" means the result passed the trial's family-wise control for false positives across all its planned tests; "nominal" means the p-value cleared the bar on its own but sat outside that control, so it carries less weight.

So the headline "greater A1C reduction" is fully backed for 12 mg. For 9 mg, the trial proved it's no worse than Ozempic, and its edge beyond that is suggestive.

Expect smaller numbers once the treatment-regimen estimand comes out, which counts everyone randomized whether or not they kept taking the drug. In TRANSCEND-T2D-1, retatrutide 12 mg weight loss was 16.8% by the efficacy estimand and 15.3% by treatment-regimen; in TRIUMPH-1 it was 28.3% and 25.0%. Lilly hasn't released treatment-regimen figures for this trial.

Why 12 mg didn't lower A1C more than 9 mg

It didn't in the earlier diabetes trials either. In TRANSCEND-T2D-1, A1C fell 2.0 points on 9 mg and 1.9 on 12 mg over 40 weeks; in TRIUMPH-2, people with obesity and type 2 diabetes saw 1.6 and 1.5 over 80 weeks. Here both doses tied at 2.2, from a higher start (8.3%, against 7.9% and 7.7% in those trials), which left more room to fall.

What the higher dose added in TRANSCEND-T2D-2 was 1.4 percentage points of weight (20.9% against 19.5%) and more stopping for side effects (7.9% against 4.8%).

Our read: for blood sugar alone, these three trials show no gain from 12 mg over 9 mg, and the extra weight comes with more people quitting. Which dose would suit whom is a question for a doctor once a label exists, and the full paper's dose-by-dose tables will matter more than the topline.

Side effects and stopping

Stomach and bowel effects led on all three drugs, and nausea came out about level. Lilly says most events were mild to moderate and typically resolved during treatment.

In plain terms, about 1 in 13 people on 12 mg (7.9%) and about 1 in 21 on 9 mg (4.8%) stopped because of side effects, against about 1 in 37 on Ozempic (2.7%). Dysesthesia, the skin-sensation effect seen across retatrutide's trials, ran at more than twice Ozempic's rate on 12 mg; retatrutide skin sensitivity covers what it feels like and how it went in other trials.

What the release leaves out matters as much: no serious adverse event rates, no death count, no low blood sugar figures, no pancreatitis or gallbladder counts and no heart rate data. Because entry was built around metformin with or without an SGLT2 inhibitor, the trial likely can't say how retatrutide behaves alongside insulin or a sulfonylurea either.

What Lilly hasn't released

The registry lists 12 secondary endpoints at week 80. Lilly's release gives numbers for three of them and a direction for three more.

Also missing as of October 31, 2026: confidence intervals, the treatment-regimen estimand, overall dropout, arm sizes, how Ozempic was stepped up, and anything from the extension. We found no journal paper in a Europe PMC search, ClinicalTrials.gov shows no posted results, and Lilly says only that details will come at a future medical meeting and in a peer-reviewed journal. The extension runs to an estimated study completion of February 2027.

What it means for Lilly's filing

This is the second of three TRANSCEND-T2D readouts, and the first with an active comparator. The third, TRANSCEND-T2D-3, tests retatrutide against placebo in about 320 people with type 2 diabetes and moderate or severe kidney impairment on basal insulin; its registry lists primary completion in October 2026 (estimated), and Lilly had announced no result as of October 31, 2026.

In its August 5, 2026 earnings filing, Lilly said its clinical data package was complete to support registrations for obesity, obstructive sleep apnea and knee osteoarthritis pain. Type 2 diabetes wasn't on that list. Neither the October 28 release nor Lilly's October 29 third-quarter filing gives a submission date or says whether diabetes will be in the first application.

Lilly last said, on September 29, 2026, that it plans to submit retatrutide to the FDA in the first quarter of 2027 as a Biologics License Application (BLA). On October 2, 2026, the FDA decided that retatrutide is a drug, not a biological product, so an application would need to be filed under section 505 of the Federal Food, Drug, and Cosmetic Act. Lilly's appeal on that question is pending in the Seventh Circuit, and we found no ruling as of October 31, 2026. The background is on retatrutide drug or biologic.

Our read: a win over the top approved Ozempic dose gives a future diabetes application direct comparison data, which placebo trials can't, but the timing of that application is Lilly's call and it hasn't stated it.

Until any approval, nothing sold online as retatrutide is Lilly's product or went through this trial; Lilly's release says anyone claiming to sell it to consumers "is breaking the law". If you've seen retatrutide for sale, that page covers what those vials turn out to contain and the regulator cases behind the warnings.

The next head-to-head is TRIUMPH-5, retatrutide against tirzepatide in about 800 adults with obesity, with primary completion estimated for November 2026.