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 typical first-line remedy for the situation. For those who’re taking a GLP-1 drug for the primary time, you may 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 school and seemingly much less impactful medicine like metformin when you’re taking one of many latest diabetes and weight reduction medicine in the marketplace?
“Diabetes is a posh well being situation,” explains Vanessa King RDN, CDCES, a spokesperson for the Academy of Diet and Dietetics. “In case your A1C is greater than 1.5 p.c above your goal, a mix medicine remedy is now the commonest technique per the requirements of the American Diabetes Affiliation.” Meaning taking a couple of diabetes drug without delay. Even if you’re assembly your blood sugar targets with metformin, your clinician might advocate including a GLP-1 drug for its different well being advantages.
In truth, these two diabetes medicines work very otherwise even whereas offering related advantages. Consultants say they work higher when taken collectively. Right here’s what it’s essential know.
Metformin vs. GLP-1s: How Do They Work?
Metformin is a capsule that sufferers take as soon as or a number of occasions per day. GLP-1 medicines are typically taken as soon as per week by way of injection, or much less generally with a each day pill or each day injections.
“Metformin and GLP-1s (like Ozempic) are sometimes prescribed collectively to handle blood sugar ranges for individuals with kind 2 diabetes,” explains King, “as a result of they’re various kinds of drugs that work in synergistic and complementary methods.”
Metformin works principally by telling your liver to provide much less sugar, says King.
“Ozempic and Mounjaro, however, work by imitating intestine hormones that enhance your physique’s insulin manufacturing if you’re consuming, decelerate how shortly meals strikes by means of the digestive tract, and enhance satiety and fullness if you’re consuming,” provides King. “GLP-1s scale back liver glucose manufacturing, too.”
Whereas most of the advantages do overlap, every class of medicine provides totally different advantages.
Advantages of Metformin
Lengthy thought of the “first line of protection” in treating kind 2 diabetes, metformin works primarily by suppressing how a lot glucose (sugar) the liver produces. It will probably additionally scale back your urge for food, scale back how a lot sugar is absorbed from the carbohydrates you eat, and decelerate the digestion of your meal. All these results can assist with a small quantity of weight reduction.
“There are such a lot of advantages of metformin. Metformin truly will increase your physique’s pure GLP-1 manufacturing,” explains Lori Wenz, NP, a nurse practitioner who’s been caring for individuals 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 constructive modifications within the intestine microbiome in individuals taking metformin,” says Wenz. “We all know metformin modifications the way you take up macronutrients, notably carbohydrates, however probably fat and proteins, too.”
Current analysis suggests metformin can scale back your threat of creating a number of different well being situations, 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 embrace that it’s protected,” provides King. “And it doesn’t trigger weight acquire, is extremely efficient when taken persistently, doesn’t trigger hypoglycemia, and it’s comparatively inexpensive.”
Whereas the influence of metformin is considerably extra refined 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 best weight reduction medicines ever developed. Although individuals with diabetes are likely to lose much less weight utilizing a GLP-1, the entire loss can nonetheless be spectacular. On the very best accredited dosages, individuals 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 Day by day.
Whereas it’s been properly established that GLP-1s can assist you reduce weight and enhance blood glucose ranges, analysis continues to disclose different potential and important advantages for different elements of your well being.
“GLP-1s like Ozempic have cardiovascular and kidney advantages as properly,” explains King. “Analysis reveals it will possibly shield sufferers with coronary heart illness, coronary heart failure, or power kidney illness. However it will possibly additionally scale back your threat of those situations when you’re high-risk, together with individuals 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 situations which can be usually problems of kind 2 diabetes.[2][3]
GLP-1s and Metformin Are Most Useful When Mixed
“Now we have information from previous trials that tirzepatide with metformin present higher weight discount than tirzepatide alone,” explains Wenz on the advantages of Mounjaro. “Some individuals assume you don’t want anything, or that metformin isn’t as efficient, however we all know these medicines are only if 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 unintended effects, a few of which overlap. Metformin is thought to trigger gastrointestinal misery, generally diarrhea. Nausea and vomiting happen in as much as 30 p.c of customers.[4] And GLP-1s have shortly grow to be recognized for their very own gastrointestinal unintended effects, which have an effect on a fair increased share of customers.
“Each medicines have potential digestive unintended effects and this may be one concern with taking them collectively,” says King.
“We work on a case-by-case foundation to scale back the gastrointestinal unintended 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 unintended effects are likely 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 might be splendid to take each these medicines — when you can entry them.
“There may be a lot buzz round Ozempic and Mounjaro associated to weight reduction, however these medicine are cost-prohibitive for many individuals,” says King. “Many sufferers admire 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 might be troublesome to seek out due to ongoing shortages. Against this, metformin could be very inexpensive and straightforward to get insurance coverage protection for, too. Some insurance coverage corporations 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, nevertheless it nonetheless has an essential position to play in kind 2 diabetes remedy. Whereas these totally different medicine provide many related advantages, they work otherwise within the physique and can be utilized collectively for an additive impact.
