Comparison of Metformin to Other Diabetes Medications

Metformin and insulin are undeniably the most popular medications for Type 2 diabetes treatment. However, there are other options patients with Type 2 diabetes can explore to manage their blood sugar levels. 

For many people, diabetes mellitus tends to recur, and its symptoms may worsen without the right treatment. Some may even experience chronic or severe hyperglycemia before getting diagnosed with this disease.

Whichever the case, it’s important to know your options when seeking treatment. Here’s a breakdown of Metformin alternatives proven to improve diabetes and overall health.

1. Combination Drugs

With this option, your doctor may prescribe a combination of two or more drugs to make each medication powerful. It helps reduce the number of pills or injections in the therapy and reduce the potential side effects,

Common combination drugs for diabetes include Synjardy (Metformin combined with Jardiance) and Kombiglyze XY (the extended-release version of Metformin combined with Onglyza. Your doctor may also prescribe Janumet, which combines Metformin with Januvia, for your treatment.

2. Thiazolidinediones (TZDs) 

Thiazolidinediones are designed to lower blood sugar levels in the body by decreasing insulin resistance. They are usually less costly and sold as generic medications. However, TZDs can put you at risk of heart failure or weight gain.

It’s, therefore, important to weigh the risks of taking TZDs with your doctor to know the alternatives to use. Other side effects associated with Thiazolidinediones include fluid build-up on the arms, hands, legs, or feet.

3. Sulfonylureas (SFUs)

SFUs rank among the oldest medications used to treat diabetes mellitus. They work by reducing blood sugar levels in the body. However, since they come in generic versions, they carry certain side effects. 

The drugs may lower your blood sugar and make it difficult to lose weight. You may also be at risk for hypoglycemia, stomach upset, and increased appetite while taking SFUs.

4. DPP-4 Inhibitors

As a group of medications designed to lower glucose levels, DPP-4 Inhibitors limit the production of glucagon. In this case, the hormone glucagon can no longer result in a spike in blood sugar levels when you take this medication.

DPP-4 Inhibitors decrease stomach emptiness, thus giving you the sensation of fullness. They also stimulate the production of insulin to regulate blood sugar levels. However, their side effects include increased pancreatitis risk, flu-like symptoms, and gastrointestinal issues.

You can take them orally alone or in combination with Metformin to lower glucose effectively. Combining this drug with Metformin poses a low risk for low blood sugar levels, unlike combining it with insulin.

5. GLP-1 Receptor Agonists  

Your doctor can prescribe GLP-1 Receptor Agonists through an injection or oral form. Either way, these medications help lower glucose in the body. They do this by reducing the A1C levels, which reduce your body’s ability to regulate blood sugar.

On the positive side, GLP-1 Receptor Agonists can help you lose weight if you've previously tried dieting and exercise. Their side effects may include nausea, hypoglycemia risk, diarrhea, or vomiting. Drugs that fall under this category include Victoza, Trulicity, Rybelsus, Ozempic, Byetta, Bydureon, and Adlyxin.

6. SGLT-2 Inhibitors 

When taken orally, SGLT-2 Inhibitors help the body excrete excess sugars through urine. They can also slow kidney disease from progressing and reduce the risk for heart disease.

Examples of drugs sold as SGLT-2 Inhibitors include Steglatro, Jardiance, Invokana, and Farxiga. Their potential side effects include frequent urination, low blood pressure, and increased risk for diabetic ketoacidosis, kidney damage (for people with kidney disease), and UTIs (together with genital yeast infections).

The Bottom Line

Though Metformin combined with certain lifestyle changes are the sought-after therapies for diabetes mellitus, there are other options you can consider. The options will depend on your vulnerability to kidney or heart disease. Either way, discuss with your doctor the potential benefits and side effects of these medications to know whether they fit your health situation.