8 Metformin Alternatives for Type 2 Diabetes: Ozempic, Jardiance, and More

If you or your loved one are living with Type 2 diabetes, chances are you’ve heard of metformin. It’s a first-choice medication to lower blood glucose (sugar) among people living with diabetes, and it’s very commonly prescribed. It can also help some people lose weight, among other effects.

But is it the best medication to treat Type 2 diabetes? That depends. Despite metformin’s popularity, there may be an alternative that works better for you. This is especially the case if you can’t take or tolerate metformin.

Some people with diabetes might only need to take one medication for treatment. Others need to take more than one. Thankfully, there are different types of diabetes medications available. And many of them can be used in combination with each other.

If you can’t take metformin or it’s not doing enough, here are eight metformin alternatives for Type 2 diabetes you can discuss with a healthcare professional.

Is metformin the best medication for Type 2 diabetes?

Experts traditionally recommend metformin as a first-choice medication for Type 2 diabetes. It can lower hemoglobin A1C (HbA1C or A1C) by up to 1.5% and doesn’t generally cause episodes of low blood glucose, also known as hypoglycemia. It’s also quite affordable.

But this traditional approach is changing. New medications continue to be FDA approved, and several of them are now prescribed as preferred treatments. They can be used along with — or in place of — metformin for certain people.

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What are the best alternatives to metformin for Type 2 diabetes?

Many people with Type 2 diabetes struggle to hit their A1C and body weight goals. Heart failure, heart disease, or chronic kidney disease (CKD) can also be related issues. Certain medications have benefits over metformin in these scenarios.

1. GLP-1 agonists like Ozempic

Glucagon-like peptide-1 (GLP-1) agonists have been widely discussed in healthcare and news circles over the past few years. Common GLP-1 agonists include:

• Ozempic (injectable semaglutide)

• Rybelsus (oral semaglutide)

• Trulicity (dulaglutide)

• Victoza (liraglutide)

GLP-1 agonists like these can lower A1C by up to 1.5%, proving to be very effective. They’re now the preferred injectable medications over insulin.

And they have more than just glucose-lowering benefits. A GLP-1 agonist with proven heart benefits is a recommended metformin alternative if you have heart disease. They can also lower body weight by up to 15 lbs (7 kg), depending on the medication and dosage. In fact, some of them are approved specifically for weight loss — under the names Wegovy (semaglutide) and Saxenda (liraglutide).

2. SGLT2 inhibitors like Jardiance

The most common sodium-glucose cotransporter-2 (SGLT2) inhibitors are Farxiga (dapagliflozin), Jardiance (empagliflozin), and Invokana (canagliflozin). SGLT2 inhibitors are oral pills that are taken once daily. They can lower A1C by up to 1% and reduce body weight by at least 4 lbs (2 kg).

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If metformin alone isn’t enough, adding an SGLT2 inhibitor may help. An SGLT2 inhibitor may also be prescribed on its own as a preferred option. SGLT2 inhibitors come in combination tablets with metformin for convenient dosing too. And a SGLT2 inhibitor with proven benefits, such as Jardiance, is preferred in people with a history of heart or kidney disease. Your heart and your kidneys are linked, and SGLT2 inhibitors can help protect both.

3. Mounjaro

Mounjaro (tirzepatide) is one of the newest metformin alternatives. It’s a once-weekly injection that comes in six doses.

It's also the first medication of its type. Mounjaro is a dual glucose-dependent insulinotropic polypeptide (GIP) and GLP-1 agonist. Mounjaro’s dual role makes it potentially more effective than using a GLP-1 agonist (like Ozempic) alone. 

In the initial clinical trials that it was studied in, it lowered A1C by over 2% for some people and reduced body weight up to 25 lbs (11 kg) — when used in combination with metformin. It reduced body weight by up to 17 lbs (8 kg) when used alone.

These are Mounjaro’s biggest strengths — how well it can lower A1C and body weight. It’s a preferred medication to consider, especially if losing weight is a priority.

4. Insulin

Insulin is a necessary treatment for people with Type 1 diabetes. But in certain cases, people with Type 2 diabetes may need to start using insulin, too. This may be the case when your diabetes is more advanced. Insulin is also a good alternative if you have advanced kidney disease and can’t take metformin.

There are different types of insulin available depending on your needs, preferences, and health background. Insulin is available through an injection, an inhaler, or a continuous insulin pump. Talk to a healthcare professional about whether insulin is a good option for you.

5. DPP-4 inhibitors like Januvia

Dipeptidyl peptidase 4 (DPP-4) inhibitors, also known as gliptins, are other metformin alternatives. This class includes Januvia (sitagliptin), Tradjenta (linagliptin), and Nesina (alogliptin).

These once-daily oral pills lower A1C up to 0.8%, making them less effective than metformin in general. These medications are often used in combination with metformin if you are very close to your target A1C but need a bit more support.

DPP-4 inhibitors usually have mild side effects and a neutral effect on body weight. So if you can’t tolerate metformin, they may be a good option to use instead.

6. Thiazolidinediones like Actos

Actos (pioglitazone) is the only thiazolidinedione (also called a glitazone or TZD) currently available. Actos can take anywhere from 6 weeks to 6 months to start working and lowers A1C by around 1%. But it can add to weight gain, so it’s not generally a first-choice medication.

If metformin alone is not enough to reach your A1C goal, and other medications aren’t available or appropriate for your situation, adding a TZD, such as Actos is an option.

7. Sulfonylureas like glipizide

Sulfonylureas are another group of diabetes medications. Common sulfonylureas include glipizide, glyburide (Glynase, DiaBeta), and glimepiride (Amaryl).

These oral pills can lower A1C by about 1%, but they have a high risk of causing hypoglycemia. They may also lead to a modest amount of weight gain. Your prescriber will help decide if adding a sulfonylurea to your routine would be worthwhile.

8. Combination medications

Combination medications — formulated with metformin and another oral medication — can be useful and convenient. If you don’t like the idea of taking multiple pills, a combination product can help simplify your daily medication regimen.

Several metformin combination products are available. For instance, the pairing of metformin and a DPP-4 inhibitor includes medications such as Janumet (sitagliptin / metformin) and Jentadueto (linagliptin / metformin). The combination of metformin with an SGLT2 inhibitor includes:

• Synjardy (empagliflozin / metformin)

• Invokamet (canagliflozin / metformin)

• Xigduo XR (dapagliflozin / metformin)

If you take these medications separately, switching to a combination medication can help. It helps lower the number of daily pills and makes dosing more convenient. But, the most cost-effective choice can depend on your situation, specific medications, and insurance status.

Are there any natural alternatives to metformin?

There aren’t any natural alternatives, such as vitamins or supplements, that are approved to treat diabetes. Although certain natural products may be useful, they should not replace a prescription medication. As with routine exercise and a diabetes-friendly diet, they’re better to be used as a sidekick to your other medications.

If you’re interested in taking a vitamin or supplement to lower your blood glucose, talk with your pharmacist or prescriber. They can offer guidance on whether it’s safe to add to your routine. In some cases, they can lead to extra side effects or interactions.

When should you talk to your healthcare professional about metformin alternatives?

Choosing the right medication isn’t simple. Metformin isn’t the best choice for everyone. You should talk to a healthcare professional about metformin alternatives if you:

• Can’t tolerate metformin due to side effects

• Can’t take metformin because your kidney function is low

• Have other health conditions, such as a history of heart disease or heart failure

• Are not meeting your blood glucose and A1C targets with metformin alone

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Written by:

Hindu Rao, PharmD, APh, BCACP

Hindu Rao, PharmD, APh, BCACP is a clinical assistant professor of pharmacy practice at Chapman University School of Pharmacy and a clinical pharmacist at Providence Medical Foundation. She specializes in chronic disease management and has her board certification in ambulatory care.

Written by:

Mandeep Sohal, PharmD

Mandeep Sohal, PharmD, has more than 7 years of experience in the pharmaceutical industry and is licensed in California. In his career, he’s had experience with specialty pharmacy, community pharmacy, pharmacy benefit management, and pharmaceutical manufacturers.

Reviewed by:

Christina Aungst, PharmD

Christina Aungst, PharmD, is a pharmacy editor for GoodRx. She began writing for GoodRx Health in 2019, transitioning from freelance writer to editor in 2021.

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