Metformin vs GLP-1: What’s the Difference and Which is Right for You?

GLP-1 vs Metformin: What Should You Know?

If you’ve recently been diagnosed with type 2 diabetes or prediabetes, or you’re reassessing how well your current plan is working, you’ve probably heard the same two names come up again and again: metformin and GLP-1 medications. They’re often discussed in the same breath, but they play very different roles in blood sugar management.

Metformin has been a first-line option for decades. It’s familiar, widely prescribed, and well-studied. GLP-1 receptor agonists are newer to the scene but have gained attention for their effectiveness for both glucose control and weight management.

So, which one makes more sense for you? This decision usually comes down to various factors and must be determined with the help of a licensed healthcare provider. So, let’s take a closer look.

‍

What Is Metformin?

Metformin is one of the most widely prescribed medications for type 2 diabetes. It belongs to a class of drugs called biguanides, and it works primarily by reducing the amount of glucose your liver produces while also helping your body use insulin more effectively.

Since it doesn’t cause the body to make more insulin, metformin carries a low risk of causing blood sugar to drop too low (hypoglycemia). It’s taken orally, usually once or twice a day, and is available in both immediate-release and extended-release forms.

Beyond diabetes, metformin is also commonly prescribed off-label for polycystic ovary syndrome (PCOS), where it can help regulate the menstrual cycle and improve insulin sensitivity (a common issue with PCOS). In fact, its affordability and long track record make it a go-to option for many healthcare providers.

‍

{{primary-cta}}

‍

What Are GLP-1 Medications?

GLP-1 medications (or GLP-1 receptor agonists) work by mimicking a natural hormone called glucagon-like peptide-1. This hormone supports blood sugar regulation.

Essentially, it signals the pancreas to release insulin when blood sugar rises, slows down digestion so glucose enters your bloodstream more gradually, and plays a role in appetite regulation.

Most GLP-1 medications are administered by injection (daily or weekly, depending on the specific drug). But an oral option is now available as well. Originally developed for type 2 diabetes, certain FDA-approved GLP-1 medications are also indicated for chronic weight management.

‍

Metformin vs GLP-1: Key Differences

Both metformin and GLP-1 medications help manage blood sugar, but they do so in distinct ways. Here’s how they compare across a few important factors.

‍

How They Work

Metformin primarily targets the liver, reducing the amount of glucose it releases into the bloodstream. It also improves how your body responds to insulin, without increasing insulin production itself.

In contrast, GLP-1 stimulates insulin release from the pancreas (but only when blood sugar is elevated), slows gastric emptying so glucose enters your system more gradually, and acts on hunger signals in the brain.

‍

How They’re Taken

Metformin is an oral medication, typically taken once or twice daily in tablet or liquid form. Extended-release versions allow for once-daily dosing, which some people find more convenient.

Most GLP-1 medications are injectable, either daily or weekly, depending on the specific drug. A weekly injection can simplify routines for those who prefer fewer doses. There is also an oral GLP-1 option (semaglutide) for those who prefer to avoid injections altogether.

‍

Side Effects

Both medications can cause gastrointestinal side effects, especially when you first start taking them. In other words, nausea, diarrhea, and stomach discomfort are common with both metformin and GLP-1s, though these symptoms often improve as your body adjusts.

With long-term use of metformin, vitamin B12 deficiency can occur, which is why periodic monitoring is recommended. GLP-1 medications have been associated with gallbladder issues and, in rare cases, pancreatitis, as indicated by FDA-approved products. Neither medication is likely to cause low blood sugar on its own.

‍

Cost and Accessibility

Metformin is available as a generic medication and typically costs between $4 and $15 per month without insurance. Most insurance plans cover it with minimal copays.

GLP-1 medications, however, are considerably more expensive. They often range from $800 to $1,400 per month without coverage. Overall, insurance coverage varies by your specific plan. If your plan covers a GLP-1, your out-of-pocket cost may be much lower (such as a copay), and for some FDA-approved GLP-1 brands, eligible commercially insured patients may pay as little as $25 with a manufacturer savings card (terms, eligibility, and exclusions apply). Some plans also impose restrictions on GLP-1s, particularly when they are prescribed for weight management. For instance, this may mean trying lower-cost options first, per your insurance coverage.

‍

{{primary-cta}}

‍

Metformin vs GLP-1: Which is Right for You?

The best choice depends on your individual health profile, goals, and practical considerations. A licensed healthcare provider can help determine the best fit for you.

Metformin may be a good fit if you’re newly diagnosed with type 2 diabetes or prediabetes, looking for an affordable and well-established treatment option, or managing PCOS alongside insulin resistance.

On the other hand, a healthcare provider may consider GLP-1 medications if you have cardiovascular disease or are at higher risk of heart-related complications, weight management is an important health consideration, or blood sugar targets have not been met with metformin alone.

Additionally, some people benefit from using both, starting with metformin and adding a GLP-1 later if additional support is needed for blood sugar control or weight management.

Ultimately, the best way to determine what’s right for you is to talk with a licensed healthcare provider. They can help you weigh the benefits, side effects, costs, and lifestyle factors specific to your situation.

‍

Final Thoughts

Metformin and GLP-1 medications may both play valuable roles in managing blood sugar. But they’re not technically interchangeable. 

Metformin offers decades of proven use, accessibility, and affordability. GLP-1 medications have demonstrated weight-loss and cardiovascular benefits in clinical studies of FDA-approved products, though they come at a higher cost and with different considerations.

Your decision should consider your health history, treatment goals, budget, and how each medication fits into your daily routine. With guidance from a qualified healthcare provider, you can find an approach that supports your long-term health and well-being.