Metformin alternatives for blood sugar management and more
Metformin isn't your only option for managing blood sugar. Discover powerful alternatives – from breakthrough GLP-1 injectables to proven lifestyle changes – that could better fit your needs and health goals.
Key highlights
- Metformin is often the first choice of medication for managing type 2 diabetes, but the medication is not suitable for everyone. Some people experience side effects, while others need stronger or more targeted blood sugar control.
- Several FDA-approved alternatives to metformin are available. These include medications that may offer added benefits, such as weight loss, cardiovascular protection, and kidney protection, as well as options for once-weekly dosing.
- Natural supplements and lifestyle changes may also help support blood sugar management. However, they should be used carefully and under medical guidance, as research is still ongoing.
- Consult your healthcare provider before stopping metformin and switching to another medication. They will assess your health condition, blood sugar levels, glycated hemoglobin levels, body weight, and comorbid conditions to choose the most appropriate treatment plan.
Metformin is one of the most commonly prescribed drugs for managing type 2 diabetes mellitus. This medication is part of the biguanide class of drugs. In the United States, diabetes mellitus impacts around 38 million individuals, representing a substantial segment of the population. Additionally, an estimated 98 million Americans have prediabetes. People with diabetes often experience comorbid conditions, including hypertension, elevated cholesterol, and cardiovascular disease.
This medication helps lower blood sugar levels by reducing glucose production in the liver, improving your body’s sensitivity to insulin, and supporting better glucose uptake by muscle cells. For many individuals, metformin serves as a safe and effective first-line treatment that lowers HbA1c levels and promotes long-term glycemic control. The drug may also help with mild weight loss and carries a low risk of causing low blood sugar.
However, metformin is not suitable for everyone. Metformin is contraindicated in patients with a known hypersensitivity to metformin or any biguanide, as well as in those with severe renal impairment. Additionally, some individuals may struggle with metformin compliance due to intolerable gastrointestinal (GI) side effects of metformin. While switching to the extended-release formulation may help reduce GI discomfort, it might not be sufficient to ensure consistent adherence for all patients. In other cases, you may need additional support for issues like weight management or heart health.
This article provides a complete and up-to-date guide to medications that can be used in place of metformin. We will review how these options compare in terms of effectiveness, safety, and added benefits to help you and your healthcare provider choose the right treatment plan for your needs.
Why consider alternatives to metformin
While metformin remains a trusted and widely used medication for type 2 diabetes, it may not be the right fit for everyone. There are several reasons why you and your healthcare provider might explore alternative treatments.
Gastrointestinal side effects
One of the most common reasons for switching from metformin is the presence of digestion-related side effects such as:
- Nausea
- Bloating
- Diarrhea
- Abdominal discomfort
- Metallic taste in your mouth
- Poor absorption of nutrients
The side effects of metformin can make it difficult for users to stay on the medication long term. These symptoms may lessen over time, but for some people, they remain persistent and impact quality of life.
Insufficient glycemic control
In some cases, metformin alone does not lower your A1c to target levels. If you need tighter blood sugar control, you may require an additional medication or a complete switch to a different class of drugs that work through another mechanism.
Desire for weight loss
Although metformin may lead to mild weight loss, it is not the most effective option if you are looking to lose a significant amount of weight. Some newer diabetes medications provide stronger weight loss benefits along with blood sugar control.
Need for cardiovascular or renal protection
If you are at risk for heart disease, stroke, or kidney problems, your doctor may consider other medications that offer specific protective effects. Metformin may not be safe in certain conditions, such as:
- Chronic kidney disease
- Chronic liver disease
- Unstable congestive heart failure
- Older age
Some drug classes have been shown in clinical trials to reduce the likelihood of major cardiovascular or renal complications.
Personal preferences
The form of medication you are comfortable taking also matters. While metformin is an oral tablet, some people prefer or need injectable medications due to dosing flexibility or better tolerance.
FDA-approved alternatives to metformin
If metformin is not working well for you or is not well tolerated, several other FDA-approved medications are available to help you manage type 2 diabetes. These alternatives work through different mechanisms and may offer additional benefits such as weight loss or heart protection. Your healthcare provider will help choose the best option based on your medical history, blood sugar levels, and treatment goals.
GLP-1 receptor agonists (injectable and oral)
GLP-1 receptor agonists are medications that mimic the action of a natural gut hormone called glucagon-like peptide-1 (GLP-1). This hormone plays an important role in how your body controls blood sugar and hunger.
| Mechanism of action | GLP-1 agonists mimic the action of human GLP-1 hormone and work by: • Stimulating insulin after meals • Reducing glucagon release • Slowing down gastric emptying so you feel full longer • Suppressing appetite and food cravings |
| FDA approved medications | • Ozempic (semaglutide): Weekly injection for type 2 diabetes • Wegovy (semaglutide): Weekly injection for weight loss • Rybelsus (semaglutide): Daily oral tablet for type 2 diabetes • Victoza (liraglutide): Daily injection for type 2 diabetes • Saxenda (liraglutide): Daily injection for weight loss • Trulicity (dulaglutide): Weekly injection for type 2 diabetes • Bydureon (exenatide): Weekly injection for type 2 diabetes |
| Benefits over metformin | • Lower A1c by 1.0% to 1.5% • Help with 10% to 15% weight loss • Offer cardiovascular and kidney protection (semaglutide) • Some options are weekly and easy to use |
| Side effects of GLP-1 receptor agonists | • Common side effects include nausea, vomiting, diarrhea, fatigue, constipation, gastrointestinal side effects, and appetite loss. • There is a boxed warning for thyroid tumors (especially medullary thyroid cancer or MTC) and MEN 2 syndrome, as these medications increased the risk of these tumors in animal studies. • Not recommended for people with a personal or family history of medullary thyroid cancer. • Contraindicated for pregnant and breastfeeding women and children. |
| Route of administration and dosing frequency | • Weekly injections include Ozempic, Wegovy, Trulicity, and Bydureon. • Daily injection: Victoza and Saxenda • Daily oral tablet: Rybelsus (you can take in the morning on an empty stomach) |
Ozempic (injectable semaglutide)
Ozempic (semaglutide) is a once-weekly injection, FDA-approved for reducing blood sugar levels in adults with type 2 diabetes, and reducing the risk of cardiovascular and worsening kidney disease, when used in combination with lifestyle modifications such as a low-calorie diet and exercise. In the SUSTAIN FORTE clinical trials, patients using semaglutide (Ozempic) showed an average A1c reduction of 2.2 percentage points with a 2 mg weekly dosage and 1.9 percentage points with a 1 mg weekly dosage of semaglutide after 40 weeks. The mean changes in body weight were -6.9 kg and -6.0 kg with 2 mg and 1 mg of semaglutide, respectively.
In research studies, the medication has also been shown to reduce the risk of major cardiovascular events in people with diabetes and existing heart disease. Compared to metformin, Ozempic offers greater efficacy in managing blood sugar levels and preventing cardiovascular diseases and worsening kidney disease in patients with type 2 diabetes.
Rybelsus (oral semaglutide)
Rybelsus is the only GLP-1 receptor agonist that can be taken orally. The medication is FDA-approved for managing blood sugar levels in type 2 diabetes patients. On average, Rybelsus lowered HbA1c by 1.0 to 1.3%, with 7 mg and 14 mg daily dosage after 6 months in clinical trials. Moreover, the medication reduced body weight by 4.8 pounds and 6.8 pounds with 7 mg and 14 mg, respectively, in the same clinical study. These results indicate that Rybelsus is more effective than metformin alone in reducing blood sugar, especially when combined with diet and exercise. The medication is taken once daily on an empty stomach.
Mounjaro (tirzepatide)
Mounjaro is a dual agonist at GIP and GLP-1 receptors that contains tirzepatide as an active ingredient. The medication is approved for managing blood sugar in type 2 diabetes. In clinical studies, Mounajro has shown greater A1c and weight reduction than any other GLP-1 class drug to date. In Phase 3 clinical trials, Mounjaro reduced glycated A1c levels by -2.01%, -2.24%, and -2.30% with 5 mg, 10 mg, and 15 mg weekly dosage, after 40 weeks. These outcomes are significantly stronger than those of metformin and make it a good option for patients with poor glycemic control in type 2 diabetes.
Trulicity (dulaglutide)
Trulicity is a once-weekly injectable GLP-1 agonist, FDA-approved for type 2 diabetes management and reducing the risk of heart and blood vessel-related diseases in children aged 10 or older and adults. Research studies reflect that Trulicity lowers A1c by about 1.0%. The medication has shown moderate weight loss effects and has been proven to reduce cardiovascular risk in people with type 2 diabetes and heart disease. Compared to metformin, Trulicity is more convenient due to weekly dosing.
Victoza (liraglutide)
Victoza is a GLP-1 prescription medication, which is injected once a day. The medication is FDA-approved for promoting glycemic control in adults and children with type 2 diabetes and lowering the risk of heart and blood vessel-related diseases.
In clinical trials, the medication reduced A1c levels by 1% to 1.5%. Victoza also offers modest weight loss and was shown in the LEADER trial to lower the risk of heart attack, stroke, and cardiovascular death. While metformin is generally more affordable, Victoza may be preferred for effective blood sugar control and added cardiac benefits.
Generic liraglutide
Generic versions of liraglutide have recently become available. The medication provides the same blood sugar control and cardiovascular benefits as Victoza but at a lower cost. Like the brand-name version, generic liraglutide is injected once per day.
SGLT2 inhibitors (oral)
SGLT2 inhibitors are a class of oral medications used to treat type 2 diabetes. These medications help lower blood sugar levels, support weight loss, and protect heart and kidney health. Common FDA-approved options include Jardiance (empagliflozin), Invokana (canagliflozin), and Farxiga (dapagliflozin).
| Mechanism of action | SGLT2 inhibitors work by blocking a protein in the kidneys that normally reabsorbs sugar into the bloodstream. This causes excess sugar to leave the body through urine, which lowers blood sugar levels without needing more insulin. |
| Efficacy in blood sugar control | These drugs typically reduce A1c by 0.5% to 1.0%. While less powerful than GLP-1 agonists, they offer steady blood sugar control along with modest weight loss and lower blood pressure. |
| Benefits of SGLT2 inhibitors beyond glucose control | • Reduce the risk of heart failure and the risk of hospitalizations due to heart failure • Slow down kidney disease progression • Provide cardiovascular protection, especially in high-risk individuals |
| Common side effects of SGLT2 inhibitors | • Common side effects of SGLT2 inhibitors include: Increased thirst • Increased urination • Nausea • Genital yeast infections (especially in women) • Urinary tract infections Dry mouth |
| Rare but serious risks of SGLT2 inhibitors | • Diabetic ketoacidosis (even with normal blood sugar) • Dehydration, dizziness, and low blood pressure (especially in older adults or those on diuretics) |
Jardiance (empaglifozin)
Jardiance is an oral SGLT2 inhibitor taken once daily. The medication is FDA-approved to treat type 2 diabetes, heart failure with reduced ejection fraction (HFrEF), and chronic kidney disease. The EMPA-REG OUTCOME trial showed a 38% reduction in cardiovascular death in people with type 2 diabetes and heart disease.
Jardiance also helps lower A1c by about 0.7% to 0.9%, with modest weight loss and reduced blood pressure. For people who cannot tolerate metformin or need heart protection, Jardiance is often the first SGLT2 inhibitor that healthcare providers consider.
Farxiga (dapagliflozin)
Farxiga is also taken as a once-daily tablet. The medication is FDA-approved for type 2 diabetes, chronic kidney disease, and both types of heart failure (HFrEF and HFpEF). The DAPA-HF trial showed that dapagliflozin reduced the risk of heart failure hospitalization and cardiovascular death by 26%, even in patients without diabetes. In addition, dapagliflozin, the active ingredient in Farxiga, helps promote fat loss without muscle wasting.
Invokana (canagliflozin)
Invokana is another once-daily oral SGLT2 inhibitor. It was the first medication in this class to show benefits beyond blood sugar control. The CANVAS and CREDENCE trials found that Invokana lowered the risk of cardiovascular events and delayed the progression of diabetic kidney disease.
Moreover, Invokana also lowers A1c by 1% and helps with weight reduction and blood pressure management. However, it carries a higher risk of lower-limb amputation, so careful monitoring is needed if you have foot problems.
Steglatro (ertugliflozin)
Steglatro is taken once daily and works similarly to other SGLT2 drugs. The medication is approved for type 2 diabetes and can lower A1c by about 0.8% to 0.9%. In the VERTIS CV trial, it was shown to be safe for the heart but did not significantly reduce cardiovascular events. It still helps with weight loss and blood pressure. If other SGLT2 options are too expensive or not available, Steglatro can be considered as a second-line alternative to metformin.
Brenzavvy (bexagliflozin)
Brenzavvy is the newest SGLT2 inhibitor, approved in 2023. The medication is taken once daily and lowers blood sugar by increasing the amount of glucose removed in urine. Early research shows that it can reduce A1c by about 0.5% to 0.9% and support modest weight loss. While Brenzavvy works similarly to others in this class, long-term data is still limited. If patients are unable to tolerate older SGLT2 inhibitors, Brenzavvy may be an alternative worth discussing with their doctor.
DPP-4 inhibitors (oral)
DPP-4 (dipeptidyl peptidase-4) inhibitors are a group of oral medications that help lower your blood sugar by increasing insulin release after meals. This way, they reduce the amount of sugar released by the liver. They are often prescribed when metformin is not well tolerated or when an additional medication is needed.
| Mechanism of action of DPP-4 inhibitors | They block the DPP-4 enzyme, preventing the breakdown of GLP-1 and GIP hormones. This boosts insulin release and reduces glucagon after meals, which helps lower blood sugar. |
| Effectiveness of DPP-4 inhibitors | They reduce A1c by about 0.5% to 0.8% on their own. While less potent than GLP-1s or SGLT2 inhibitors, they offer a low-risk, weight-neutral option. |
| Benefits for heart or kidney health | Most DPP-4 inhibitors have a neutral effect on cardiovascular health. Saxagliptin has shown an increased risk of heart failure in some patients, so it should be used cautiously. |
| Common side effects | These medications are generally well tolerated. Side effects of DPP-4 inhibitors include: Headache • Cold-like symptoms (nasopharyngitis) • Mild stomach upset • Joint pain • Rare allergic reactions. |
Januvia (sitagliptin)
Januvia is one of the most commonly prescribed DPP-4 inhibitors, which is FDA-approved for managing blood glucose levels in patients with type 2 diabetes when used along with lifestyle modifications. The medication is typically taken once daily at a dose of 100 mg. Januvia is weight-neutral and has a very low risk of hypoglycemia, which makes the medication suitable for most patients. In people with kidney impairment, the dose is often adjusted.
Tradjenta (linagliptin)
Tradjenta is taken once daily at 5 mg and is unique because it doesn’t require dose adjustment for kidney problems. This makes it easier to manage patients with reduced kidney function. The medication is generally well tolerated and may be used alongside other diabetes medications.
Onglyza (saxagliptin)
Onglyza is also a once-daily DPP-4 inhibitor. Studies like the SAVOR-TIMI 53 trial found a potential risk of heart failure in some patients. Healthcare providers may avoid it in those with existing cardiovascular issues. However, the medication is still an option for blood sugar control when other medications are not suitable.
Nesina (alogliptin)
Nesina is taken once daily, typically at 25 mg. It works similarly to other DPP-4 inhibitors and has a neutral effect on weight. Dose adjustments may be needed if you have kidney disease. Though rare, some people have reported joint pain or allergic reactions.
Sulfonylureas (oral)
Sulfonylureas are one of the oldest and most affordable classes of oral medications used to treat type 2 diabetes. They work by stimulating the pancreas to release more insulin, which helps lower blood sugar levels. This action is independent of meals, so it’s important to take them as prescribed to avoid low blood sugar.
| Mechanism of action of sulfonylureas | Sulfonylureas stimulate your pancreas to produce more insulin, helping to lower your blood sugar even if your body is resistant to insulin. |
| Efficacy of sulfonylureas | Sulfonylureas can lower A1c by around 1% to 2%, which is similar to metformin. However, the benefits come with a higher risk of hypoglycemia. |
| Weight gain | Weight gain is a common side effect of sulfonylureas. These medications increase insulin levels, which can promote fat storage. |
| Benefits of sulfonylureas for the heart or kidney health | They do not offer heart or kidney protection. Unlike SGLT2 inhibitors or GLP-1 drugs, sulfonylureas are not recommended for people with cardiovascular risks. |
| Benefits | Despite newer drugs, sulfonylureas are still used due to their low cost and quick effect. They may be part of a combination treatment or used when affordability is a concern. |
| Common side effects | • Gastrointestinal issues • Weight gain • Reduced appetite • Dark colored urine • Skin reactions |
Glucotrol, Glucotrol XL (glipizide)
Glipizide is one of the most commonly prescribed sulfonylureas. The medication works by prompting your pancreas to release more insulin, especially after meals. The standard Glucotrol is taken once or twice a day, ideally 30 minutes before food, while Glucotrol XL is an extended-release version designed for once-daily use.
Compared to other sulfonylureas, glipizide is often preferred in older adults or patients with mild kidney impairment because it has a shorter half-life and a lower risk of prolonged hypoglycemia. Studies suggest that glipizide can lower HbA1c by about 1.0 to 1.5%, making it as effective as metformin in the short term for some people. However, the medication does not offer the same weight neutrality or cardiovascular safety benefits.
Glynase, Diabeta (glyburide)
Glyburide (sold as Glynase or Diabeta) is a potent sulfonylurea, but it has fallen out of favor in many guidelines due to its higher risk of hypoglycemia, especially in older adults or those with kidney issues. Glyburide has a longer half-life; the effects of low blood sugar can be prolonged and harder to manage. The medication is FDA-approved for managing blood sugar levels in type diabetes when paired with a healthy diet and exercise.
Although it remains effective in lowering A1c by 1% to 2%, the ADA and BEERS criteria recommend caution when using glyburide in the elderly due to the risk of severe hypoglycemia. Its affordability continues to make it a common prescription in low-resource settings, but newer medications may be safer long-term.
Amaryl (glimepiride)
Glimepiride is considered a second-generation sulfonylurea with a more favorable safety profile than glyburide. The medication is usually taken once daily with breakfast and can be titrated gradually to minimize side effects. Like its counterparts, glimepiride helps stimulate insulin secretion regardless of blood sugar level; this is why the medication still poses a risk for hypoglycemia, especially if meals are missed or delayed.
Glimepiride has been shown to reduce A1c by up to 1.5%, and it is generally weight-positive. However, in head-to-head trials like the CAROLINA study, glimepiride did not show significant cardiovascular harm compared to DPP-4 inhibitors, which has slightly improved its standing in treatment guidelines.
Thiazolidinediones (TZDs) (oral)
Thiazolidinediones, also known as TZDs, are a class of oral diabetes medications that help your body use insulin more effectively. They are often prescribed for people with type 2 diabetes who need better blood sugar control without the frequent risk of hypoglycemia.
| Mechanism of action of TZDs | TZDs like pioglitazone and rosiglitazone increase insulin sensitivity in your muscle and fat cells. They also reduce the amount of glucose your liver releases into your blood, helping to lower blood sugar levels over time. |
| Effectiveness of TZDs for diabetes | TZDs lower A1c by about 1.0 to 1.5%, similar to metformin. They do not typically cause low blood sugar when used alone, but may lead to weight gain and fluid retention. |
| Role in heart and kidney health/ cardiovascular benefits | Pioglitazone may reduce the risk of certain heart events, especially in people with prior strokes or high cardiovascular risk. However, TZDs can worsen heart failure due to fluid retention. Rosiglitazone’s cardiovascular safety remains controversial. |
| Common side effects of TZDs | Common side effects include weight gain, swelling, and fluid buildup. There is also a potential increased risk of bone fractures, particularly in women, and worsening of congestive heart failure. |
| Safety profile | TZDs are not recommended for people with active heart failure. Your doctor may also avoid them if you have osteoporosis, liver issues, or are at high risk for bone fractures. Always consult your healthcare provider before starting. |
| Route of Administration | These medications are taken as once-daily oral pills, usually with or without food. Brand names include Actos (pioglitazone) and Avandia (rosiglitazone). |
| Can TZDs be combined with other diabetes medications? | TZDs are often prescribed alongside metformin, sulfonylureas, or insulin for additional glucose control. However, combinations may increase the risk of side effects like weight gain or fluid retention. |
Actos (pioglitazone)
Actos is a TZD used to improve insulin sensitivity in people with type 2 diabetes. The medication helps your body respond better to its own insulin and reduces how much sugar your liver releases into the bloodstream. Actos is taken once a day, with or without food.
Studies show that Actos can lower A1c by around 0.5 to 1.4% especially when used alongside metformin. The PROactive trial found that the medication may also reduce the risk of second heart attacks or strokes in people with diabetes and existing cardiovascular disease.
Avandia (rosiglitazone)
Avandia is another TZD that works similarly to Actos by helping your body use insulin more efficiently. Taken once daily, the medication also helps reduce blood sugar by targeting insulin resistance in muscle and fat tissue.
Avandia became controversial after studies raised concerns about an increased risk of heart attack. In particular, a 2007 meta-analysis published in the New England Journal of Medicine suggested a higher rate of cardiovascular events, which led to usage restrictions in several countries. These restrictions have since been lifted, but many providers still prefer other options when heart risk is a concern.
Insulin (injectable)
Insulin is essential for managing type 1 diabetes, but it may also be required in some cases of type 2 diabetes when other treatments are insufficient.
When blood sugar levels remain high despite oral medications or if type 2 diabetes progresses over time, insulin may be prescribed. Insulin directly replaces or supplements the body’s natural insulin. This helps glucose enter cells and lowers blood sugar effectively.
How does insulin work?
Insulin helps transport sugar from your bloodstream into your cells for energy. It’s the most effective way to lower blood glucose levels, especially in people with very high A1c or those who cannot take other medications.
Insulin does not provide heart or kidney protection like some newer drug classes. However, it is still a life-saving and essential treatment option when other medications are not enough.
Is Insulin better than metformin?
Insulin is stronger than metformin in controlling blood sugar, but it comes with more risks, like hypoglycemia and weight gain. The medication is often added when oral drugs no longer keep glycated hemoglobin A1c levels within the targeted range.
Side effects and considerations
Common side effects of insulin include:
- Low blood sugar (hypoglycemia)
- Weight gain
- Injection site reactions
- Possible anxiety about needles or dosage timing
How is insulin taken?
Insulin is given through injections, pens, or insulin pumps. Dosing may vary from once-daily long-acting types to multiple daily injections for meals and correction. Your doctor will choose the regimen that fits your needs and lifestyle.
| Brand name | Insulin type | Action time | Typical use |
|---|---|---|---|
| Lantus | Insulin glargine | Long-acting (24 hours) | Taken once daily to maintain baseline insulin levels. Often used at bedtime. |
| Relion | Insulin aspart | Rapid-acting (15 minutes) | Taken before meals to handle spikes in blood sugar. |
| Humalog | Insulin lispro | Rapid-acting (15 minutes) | Similar to Relion. Controls post-meal blood sugar levels. Sometimes used in insulin pumps. |
Natural and lifestyle alternatives to metformin
If you are looking for ways to manage your blood sugar beyond prescription medication, natural and lifestyle approaches may offer added support. These options work best in the early stages of type 2 diabetes or alongside a healthy treatment plan.
Natural alternatives to metformin
Some people prefer to start with natural approaches that support blood sugar control through diet, herbs, or traditional remedies. While these can be helpful in early stages or alongside lifestyle changes, they are not regulated by the FDA and should not replace prescribed medications without your doctor’s approval.
| Natural option | How it may help | What to know |
|---|---|---|
| Berberine | May improve insulin sensitivity and reduce blood sugar | Found in plants like barberry. It can cause stomach upset. Used in capsule or powder form. |
| Cinnamon | May reduce post-meal blood sugar spikes | Works best in Ceylon form. The effects are small. Often used in food or tea. |
| Fenugreek | May slow carbohydrate absorption and improve glycemic control | Typically taken as soaked seeds or powder. It can affect how your body absorbs medicine. |
| Myo-inositol | May improve insulin resistance in individuals with PCOS | Often used for hormone balance and menstrual regulation. Well tolerated. |
| Apple cider vinegar | May lower blood sugar after meals by slowing digestion | Always dilute before drinking. It can irritate the stomach or tooth enamel. |
Specific supplements to be aware of
Some supplements are often marketed as natural blood sugar solutions. While a few have shown modest effects in small studies, most lack strong, FDA-reviewed clinical evidence.
| Supplement | What you need to know |
|---|---|
| Berberine | Not FDA-approved. Quality and dosing vary across brands. May cause digestive issues. |
| Cinnamon (capsule) | As discussed earlier, it may help with fasting blood sugar, but the effects are modest. |
| Alpha-lipoic acid | May support nerve health and reduce oxidative stress It can cause nausea or dizziness. Use cautiously with other glucose-lowering drugs. |
| Chromium | Supports insulin function and glucose metabolism. Research is mixed. High doses may cause kidney or liver stress in some people. |
Lifestyle alternatives
Making changes to how you eat, how much physical activity do you have, and how do you manage stress can help improve your blood sugar levels and support long-term diabetes control. These habits may also reduce the need for medication in some people, especially in the early stages of type 2 diabetes.
Dietary changes
Low-carbohydrate, ketogenic, and Mediterranean diets can improve blood sugar control and insulin resistance. Research studies reflect that low-carb diets help lower A1c and reduce insulin needs in people with type 2 diabetes.
The Mediterranean diet focuses on nutritious whole foods, healthy fats, fiber, and limits sugar and processed foods. It has also been shown to improve metabolic health and decrease the risk of cardiovascular disease.
Regular exercise
Both aerobic and resistance training are important for blood sugar control. Structured physical activity improves A1c levels by 0.7 percent on average in people with type 2 diabetes. Resistance training, in particular, helps increase insulin sensitivity and reduce fasting glucose levels.
Weight management
Even a small amount of weight loss means a lot for your overall health. According to findings from the Diabetes Prevention Program (DPP) study, losing just 5 to 7% of body weight can decrease the risk of developing type 2 diabetes by 60% in people with prediabetes. Weight loss also improves insulin resistance and blood sugar regulation.
Stress and sleep
Chronic stress and poor sleep are two overlooked factors that can affect blood sugar levels. Studies show that mindfulness, deep breathing, and yoga help lower cortisol levels and improve glycemic control. Poor sleep has also been associated with higher insulin resistance. Getting 7 to 8 hours of restful sleep each night is one of the easiest ways to support your overall health.
How to choose the right metformin alternative
Switching diabetes medications is a personal decision that should always be made with the help of your doctor. The process depends on your current health, treatment goals, and how your body responds. The table below explains what to expect during this transition and how to make it as smooth and safe as possible.
| What matters | What to keep in mind |
|---|---|
| How well does it lower blood sugar | Some medicines like Ozempic and Wegovy lower blood sugar more than metformin. Studies on natural options are limited. |
| If weight loss is your goal | GLP-1 medications often support the most weight loss. SGLT2 medicines can help too. A low-carbohydrate diet may improve results. |
| Other health issues you have | If you have heart or kidney problems, some diabetes medicines also protect those organs. Your doctor may recommend one with added benefits. |
| Managing PCOS | For PCOS, lifestyle changes with myo-inositol often work well. Some medicines, like DPP 4 inhibitors, may also help, but are not the first choice. GLP-1 agonists such as Ozempic may also be helpful. |
| Your risk of low blood sugar | Newer medicines like GLP-1 and SGLT2 types have a decreased risk of causing low blood sugar levels. Older medicines like sulfonylureas carry a higher risk. |
| How do you prefer to take it? | Some medications come in the form of oral pills which others are avaialble in the form of injections. If you prefer tablets, ask your doctor about oral medicatioons such as Rybelsus. |
| Cost and insurance | Newer treatments can be expensive and may need insurance approval. Older medicines and natural supplements usually cost less. |
| How your body reacts | The choice of medication depends on how your body reacts to the medication. Side effects can vary from person to person. Some people feel nausea, vomiting, constipation, and gastrointestinal problems at first with GLP-1agonists. SGLT2 medicines may increase urination. |
| Other medications you are taking | Your doctor will check for any possible interactions between your new medicine and the ones you already take. Safety comes first. |
How to safely switch to a metformin alternative
Not all diabetes medications work the same way, and the right option for you depends on several factors. Your blood sugar goals, other health conditions, budget, and personal preferences all play a role. You should keep the following considerations in mind when choosing a metformin alternative and discussing it with your healthcare provider.
- Talk to your doctor: Explain your reasons for switching. This may include side effects, cost, or the need for better results. Your doctor will help you decide if a new medication is right for you
- Health evaluation: Your provider will check your A1c, kidney function, body weight, and other health conditions to choose the safest and most effective alternative.
- Transition plan: Some drugs can be started immediately, while others require slowly lowering your metformin dose to avoid blood sugar spikes or side effects.
- Follow-up monitoring: You’ll need regular check-ups and lab tests to see how your new medication is working and adjust the dose if needed. This helps keep your blood sugar in a safe range.
Metformin alternatives FAQs
What is the closest drug to metformin?
GLP-1 receptor agonists like Ozempic and Rybelsus work differently than metformin but offer similar benefits, such as reducing blood sugar and improving weight loss. However, the closest natural alternative often mentioned is berberine. It may help reduce blood sugar by improving insulin sensitivity, similar to metformin, but it is not FDA-approved and has less reliable research. GLP-1 drugs are clinically proven and FDA-approved, but are more expensive and can cause nausea.
Can I replace metformin with diet alone?
In some cases, especially in early or mild type 2 diabetes, lifestyle changes, such as a healthy diet, weight loss, and regular exercise, may help keep your blood sugar levels in a safe range without medication. This is more likely if your A1c is only slightly elevated and you have no other complications.
However, most people will need medication eventually, even with a healthy lifestyle. Diet alone is not a guaranteed long-term replacement for metformin. Always speak to your doctor before stopping the use of any medication, and make sure your blood sugar is being monitored regularly if you are trying to manage diabetes with diet alone.
Are metformin alternatives safe for the kidneys?
Yes, but it depends on the type of metformin alternative. SGLT2 inhibitors like Jardiance and Farxiga not only help lower blood sugar but also offer proven protection for kidney function, especially in people with diabetes-related kidney issues.
On the other hand, sulfonylureas like glipizide or glyburide may increase the risk of low blood sugar and are not ideal for patients with advanced kidney disease. Metformin itself is not recommended for people with severely reduced kidney function due to the rare risk of lactic acidosis.
What is the best metformin alternative for PCOS weight gain?
If you have PCOS and are finding it hard to manage weight gain, medications like Ozempic, Wegovy, or Saxenda may be worth discussing with your doctor. These GLP-1 receptor agonists work by improving insulin response, curbing appetite, and supporting steady weight loss.
Research shows that semaglutide (the active ingredient in Ozempic) can help reduce both weight and insulin resistance in women with PCOS. Some people also try natural supplements like berberine, but these are not FDA-approved, and results can vary. Birth control pills and hormone treatments can help with other symptoms, but for weight, GLP-1s tend to be most effective.
Risks and limitations of alternatives
While alternatives to metformin can offer stronger blood sugar control, weight loss, or additional heart and kidney benefits, they also come with certain trade-offs. It is important to understand these risks before making a switch.
Pharmaceutical alternatives
Some diabetes medicines like GLP-1 receptor agonists and SGLT2 inhibitors work very well, but they can be costly. You might need approval from your insurance before you can start them. Some of these drugs come as weekly or daily injections, which are not suitable for everyone.
These medicines can also cause side effects like nausea, dehydration, or urinary tract infections. They may not be safe for people with certain health problems. Your doctor will help you decide if these treatments are right for you.
Natural supplements
Some people use natural supplements like berberine or cinnamon to help manage their blood sugar. However, these are not approved by the FDA, and the amount or quality can be different from brand to brand. Research on these supplements is still limited, and results are not always consistent.
Natural supplements can also interact with other medications you take. They should not be used as a replacement for prescription drugs unless your doctor says it is safe.
Lifestyle changes
Eating healthy and staying active are important parts of managing diabetes, even if you take medication. These habits can help improve blood sugar levels and support long-term health. They take time, effort, and consistency to work.
Maintaining a healthy routine can be hard for many people. Weight loss is often slow, and results can be different for everyone. Strict diets may also affect your mood or cause stress. Without support, it’s easy to lose motivation and see your blood sugar go up again.
Conclusion: Choosing the metformin alternative that is right for you
There are many alternatives available for people who cannot take metformin or need additional support. These include newer drug classes such as GLP-1 receptor agonists and SGLT2 inhibitors that offer both blood sugar control and added benefits for weight loss and organs such as your heart and kidneys.
More affordable oral medications like sulfonylureas and TZDs are also used in certain cases. Some people consider natural supplements or structured lifestyle changes like diet and exercise, which can offer modest benefits when done consistently.
However, stopping metformin suddenly can lead to sharp increases in blood glucose levels. Always talk to your healthcare provider before making any changes to your treatment plan. The right alternative depends on your medical history, treatment goals, and how your body responds. A thoughtful, personalized approach is the safest way to manage type 2 diabetes and support your long-term health.
