This content material initially appeared on On a regular basis Well being. Republished with permission.
By Ginger Vieira
Medically Reviewed by Elise M. Brett, MD
GLP-1 medicines like semaglutide (Ozempic) and tirzepatide (Mounjaro) proceed to make headlines for his or her influence on weight problems and diabetes. You probably have kind 2 diabetes, you’ve in all probability already been prescribed metformin, a standard first-line remedy for the situation. If you happen to’re taking a GLP-1 drug for the primary time, you would possibly ponder whether or not it is sensible to proceed taking metformin.
Metformin is among the many oldest kind 2 diabetes medicine, developed over 100 years in the past.[1] Why would you want such an old style and seemingly much less impactful medicine like metformin in case you’re taking one of many latest diabetes and weight reduction medicine available on the market?
“Diabetes is a posh well being situation,” explains Vanessa King RDN, CDCES, a spokesperson for the Academy of Vitamin and Dietetics. “In case your A1C is greater than 1.5 % above your goal, a mix medicine remedy is now the commonest technique per the requirements of the American Diabetes Affiliation.” Which means taking multiple diabetes drug without delay. Even in case you are assembly your blood sugar objectives with metformin, your clinician might suggest including a GLP-1 drug for its different well being advantages.
Actually, these two diabetes medicines work very otherwise even whereas offering related advantages. Consultants say they work higher when taken collectively. Right here’s what you want to know.
Metformin vs. GLP-1s: How Do They Work?
Metformin is a capsule that sufferers take as soon as or a number of instances per day. GLP-1 medicines are typically taken as soon as every week by way of injection, or much less generally with a every day pill or every day injections.
“Metformin and GLP-1s (like Ozempic) are sometimes prescribed collectively to handle blood sugar ranges for folks with kind 2 diabetes,” explains King, “as a result of they’re various kinds of medication that work in synergistic and complementary methods.”
Metformin works largely by telling your liver to provide much less sugar, says King.
“Ozempic and Mounjaro, alternatively, work by imitating intestine hormones that enhance your physique’s insulin manufacturing while you’re consuming, decelerate how rapidly meals strikes by means of the digestive tract, and enhance satiety and fullness while you’re consuming,” provides King. “GLP-1s cut back liver glucose manufacturing, too.”
Whereas lots of the advantages do overlap, every class of medication presents totally different advantages.
Advantages of Metformin
Lengthy thought-about the “first line of protection” in treating kind 2 diabetes, metformin works primarily by suppressing how a lot glucose (sugar) the liver produces. It may possibly additionally cut back your urge for food, cut back how a lot sugar is absorbed from the carbohydrates you eat, and decelerate the digestion of your meal. All these results will help with a small quantity of weight reduction.
“There are such a lot of advantages of metformin. Metformin really will increase your physique’s pure GLP-1 manufacturing,” explains Lori Wenz, NP, a nurse practitioner who’s been caring for folks with kind 2 diabetes and weight problems for over 10 years at Western Colorado Weight Care in Grand Junction.
However Wenz says researchers are nonetheless studying about less-obvious advantages of metformin.
“In analysis, we additionally see optimistic modifications within the intestine microbiome in folks taking metformin,” says Wenz. “We all know metformin modifications the way you take in macronutrients, significantly carbohydrates, however probably fat and proteins, too.”
Latest analysis suggests metformin can cut back your danger of growing a number of different well being circumstances, too, together with dementia, most cancers, and age-related macular degeneration.
“There’s nonetheless a lot we don’t know concerning the potential advantages of metformin,” says Wenz.
King factors to previous analysis that additionally suggests metformin can enhance LDL levels of cholesterol.
“Different advantages of metformin embody that it’s secure,” provides King. “And it doesn’t trigger weight acquire, is very efficient when taken constantly, doesn’t trigger hypoglycemia, and it’s comparatively reasonably priced.”
Whereas the influence of metformin is considerably extra delicate and gradual than that of GLP-1s, it’s nonetheless helpful for nearly anybody with diabetes, no matter different medicines.
Advantages of GLP-1s
GLP-1 medicine are virtually definitely the simplest weight reduction medicines ever developed. Although folks with diabetes are inclined to lose much less weight utilizing a GLP-1, the overall loss can nonetheless be spectacular. On the best authorised dosages, folks with diabetes lose a median of 15 kilos (lb) on Ozempic, and 27 lb on Mounjaro, in line with On a regular basis Well being’s community web site Diabetes Every day.
Whereas it’s been nicely established that GLP-1s will help you shed some pounds and enhance blood glucose ranges, analysis continues to disclose different potential and vital advantages for different components of your well being.
“GLP-1s like Ozempic have cardiovascular and kidney advantages as nicely,” explains King. “Analysis exhibits it could actually defend sufferers with coronary heart illness, coronary heart failure, or continual kidney illness. However it could actually additionally cut back your danger of those circumstances in case you’re high-risk, together with folks with diabetes.”
In analysis GLP-1 medicines have dramatically delayed the development of kidney illness, and diminished the danger of loss of life from a coronary heart assault or stroke, two critical circumstances which can be typically problems of kind 2 diabetes.[2][3]
GLP-1s and Metformin Are Most Useful When Mixed
“We have now information from previous trials that tirzepatide with metformin present larger weight discount than tirzepatide alone,” explains Wenz on the advantages of Mounjaro. “Some folks assume you don’t want the rest, or that metformin isn’t as efficient, however we all know these medicines are best while you take them collectively.”
Wenz encourages her sufferers to take each — if they will entry and tolerate each.
“Sufferers positively get an additive profit when taking metformin and Ozempic together,” says King.
GLP-1 and Metformin Facet Results
Each these drug households include negative effects, a few of which overlap. Metformin is thought to trigger gastrointestinal misery, generally diarrhea. Nausea and vomiting happen in as much as 30 % of customers.[4] And GLP-1s have rapidly grow to be recognized for their very own gastrointestinal negative effects, which have an effect on a good greater proportion of customers.
“Each medicines have potential digestive negative effects and this may be one concern with taking them collectively,” says King.
“We work on a case-by-case foundation to cut back the gastrointestinal negative effects,” says King. “In some circumstances, sufferers do discontinue taking both medicine. Fortunately, there are such a lot of totally different choices for diabetes medicines.”
With each medicine, the commonest negative effects are inclined to subside after days, weeks, or months, because the physique turns into accustomed to the brand new medicine or a better dosage.
Entry and Affordability
It could be supreme to take each these medicines — in case you can entry them.
“There’s a lot buzz round Ozempic and Mounjaro associated to weight reduction, however these medicine are cost-prohibitive for many individuals,” says King. “Many sufferers recognize the low value of metformin and the truth that it’s taken orally versus an injection.”
GLP-1 medicines are costly, troublesome to get insurance coverage protection for, and could be troublesome to search out due to ongoing shortages. Against this, metformin may be very reasonably priced and straightforward to get insurance coverage protection for, too. Some insurance coverage firms may very well require you to take metformin earlier than you’re eligible for a GLP-1.
The Takeaway
Metformin isn’t as highly effective as semaglutide or tirzepatide, but it surely nonetheless has an essential position to play in kind 2 diabetes remedy. Whereas these totally different medicine supply many related advantages, they work otherwise within the physique and can be utilized collectively for an additive impact.
