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 impression on weight problems and diabetes. You probably have sort 2 diabetes, you’ve in all probability already been prescribed metformin, a standard first-line remedy for the situation. When you’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 sort 2 diabetes medicine, developed over 100 years in the past.[1] Why would you want such an old style and seemingly much less impactful remedy like metformin when 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 Diet and Dietetics. “In case your A1C is greater than 1.5 p.c above your goal, a mix remedy remedy is now the commonest technique per the requirements of the American Diabetes Affiliation.” Which means taking a couple of diabetes drug directly. Even if you’re assembly your blood sugar objectives with metformin, your clinician might advocate including a GLP-1 drug for its different well being advantages.
In reality, these two diabetes medicines work very in another way even whereas offering related advantages. Specialists say they work higher when taken collectively. Right here’s what it is advisable 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 usually taken as soon as every 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 folks with sort 2 diabetes,” explains King, “as a result of they’re several types 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, however, work by imitating intestine hormones that improve your physique’s insulin manufacturing whenever you’re consuming, decelerate how shortly meals strikes by way of the digestive tract, and improve satiety and fullness whenever you’re consuming,” provides King. “GLP-1s scale back liver glucose manufacturing, too.”
Whereas most of the advantages do overlap, every class of medication gives totally different advantages.
Advantages of Metformin
Lengthy thought-about the “first line of protection” in treating sort 2 diabetes, metformin works primarily by suppressing how a lot glucose (sugar) the liver produces. It will possibly 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 really will increase your physique’s pure GLP-1 manufacturing,” explains Lori Wenz, NP, a nurse practitioner who’s been caring for folks with sort 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 adjustments within the intestine microbiome in folks taking metformin,” says Wenz. “We all know metformin adjustments the way you take up macronutrients, notably carbohydrates, however probably fat and proteins, too.”
Latest analysis suggests metformin can scale back your threat of creating 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 embrace that it’s protected,” provides King. “And it doesn’t trigger weight acquire, is very efficient when taken persistently, doesn’t trigger hypoglycemia, and it’s comparatively inexpensive.”
Whereas the impression of metformin is considerably extra delicate and gradual than that of GLP-1s, it’s nonetheless useful 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 entire loss can nonetheless be spectacular. On the very best accepted dosages, folks with diabetes lose a median of 15 kilos (lb) on Ozempic, and 27 lb on Mounjaro, in response to On a regular basis Well being’s community web site Diabetes Every day.
Whereas it’s been properly established that GLP-1s can assist you drop extra pounds and enhance blood glucose ranges, analysis continues to disclose different potential and vital advantages for different elements of your well being.
“GLP-1s like Ozempic have cardiovascular and kidney advantages as properly,” explains King. “Analysis exhibits it may defend sufferers with coronary heart illness, coronary heart failure, or persistent kidney illness. However it may additionally scale back your threat of those circumstances when 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 chance of demise from a coronary heart assault or stroke, two critical circumstances which might be usually issues of sort 2 diabetes.[2][3]
GLP-1s and Metformin Are Most Helpful When Mixed
“Now we have knowledge from previous trials that tirzepatide with metformin present higher weight discount than tirzepatide alone,” explains Wenz on the advantages of Mounjaro. “Some folks suppose you don’t want anything, or that metformin isn’t as efficient, however we all know these medicines are handiest whenever you take them collectively.”
Wenz encourages her sufferers to take each — if they will entry and tolerate each.
“Sufferers undoubtedly get an additive profit when taking metformin and Ozempic together,” says King.
GLP-1 and Metformin Facet Results
Each these drug households include unwanted 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 turn into recognized for their very own gastrointestinal unwanted effects, which have an effect on an excellent increased share of customers.
“Each medicines have potential digestive unwanted 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 unwanted effects,” says King. “In some instances, sufferers do discontinue taking both remedy. Fortunately, there are such a lot of totally different choices for diabetes medicines.”
With each medicine, the commonest unwanted effects are inclined to subside after days, weeks, or months, because the physique turns into accustomed to the brand new remedy or the next dosage.
Entry and Affordability
It could be splendid to take each these medicines — when 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 respect the low value of metformin and the truth that it’s taken orally versus an injection.”
GLP-1 medicines are costly, tough to get insurance coverage protection for, and could be tough to seek out due to ongoing shortages. In contrast, metformin may 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, however it nonetheless has an essential position to play in sort 2 diabetes remedy. Whereas these totally different medicine provide many related advantages, they work in another way within the physique and can be utilized collectively for an additive impact.
