Metformin vs. Ozempic: How Do They Compare?

When it comes to managing type 2 diabetes, metformin and Ozempic are both great medication options, each with their own unique way of maintaining blood sugar levels.

While both medications provide additional benefits beyond glycemic control, they also come with unique adverse side effects. 

Metformin is a long-standing medication used for diabetes management.

It’s known for lowering blood sugar and improving insulin sensitivity. 

Ozempic, is a newer medication that offers blood sugar regulation, weight loss benefits, and reduces the risk of cardiovascular events. 

Read on for a comprehensive comparison of metformin and Ozempic. 

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What is Metformin? 

Since its approval in 1994 by the Food and Drug Administration (FDA), providers have been prescribing metformin for treating type 2 diabetes.

It is an oral medication that is available in immediate-release and slow-release forms, and providers often recommend using it with other diabetes medications, such as insulin.

Metformin is FDA-approved to treat adults and children over the age of 10.

Several off-label uses include treating gestational diabetes, minimizing weight gain from antipsychotic drugs, and treating or preventing polycystic ovarian syndrome. 

Mechanism of Action 

Metformin is from the biguanide drug class and is the only drug of its kind.

It performs three mechanisms of action:

• Decreasing glucose production in the liver.
• Decreasing sugar absorption in the intestines.
• Enhancing insulin sensitivity.

Effectiveness 

Metformin has a long and proven safe and effective track record.

It’s also very affordable. 

In studies, it has been shown to reduce hemoglobin A1c by up to 2%.

This test gives a three-month snapshot of your blood sugar’s average range. 

Additional benefits of metformin are that it very rarely causes hypoglycemia—low blood sugar, and it may help protect the cardiovascular system from damage caused by diabetes.

Common Side Effects 

Most people tolerate metformin very well when taken with food.

Less than half of metformin users experience side effects that may include:

• Diarrhea.
• Nausea.
• Vomiting.

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What is Ozempic? 

Ozempic is a newer medication the FDA approved in 2017.

Providers prescribe this medication for people with type 2 diabetes to help them manage their blood sugar.

You can take it with other FDA-approved diabetes medications such as insulin and metformin, but use caution as it can cause your blood sugar to drop too low.

This medication is approved for adult use only.

It comes in a liquid slow-release form and is administered as a once-weekly injection.

People who have a history of pancreatitis, medullary thyroid cancer, or MEN syndrome should avoid this medication and talk with their provider  about other options for managing their blood sugar.

While Ozempic may help you lose some weight, it is not approved as a weight-loss medication.

However, some providers may prescribe this medication off-label to help people lose weight. 

Mechanism of Action

Ozempic is a glucagon-like peptide 1 (GLP-1) receptor agonist that works alongside eating healthy and exercising regularly.

It mimics the actions of a naturally occurring hormone and has three ways of working to keep your blood sugar stable. 

• Stimulates your pancreas to produce more insulin when your blood sugar rises. 
• Decreases the amount of glucose (sugar) your liver produces.
• Slows down how quickly food leaves your stomach during digestion.

Effectiveness

Ozempic doesn’t have a long track record like metformin, but results from the clinical trials are very positive.

After 30 weeks of using Ozempic, up to 73% of clinical trial participants got their HgA1c results in the healthy range below 7%.

Ozempic is also effective at reducing the risk of heart attack and stroke for people with type 2 diabetes who also have cardiovascular disease. 

Common Side Effects 

Some people experience side effects when they start using Ozempic.

However, these symptoms typically fade as their body adjusts to the medication. Common side effects include:

• Nausea.
• Vomiting.
• Diarrhea.
• Constipation.
• Abdominal pain.

Key Differences Between Metformin and Ozempic

While metformin and Ozempic are both medications prescribed for type 2 diabetes management, they have several distinct differences.

Mechanism Of Action

Each medication works differently in your body to help you manage your blood sugar.

Metformin primarily works to increase insulin sensitivity, reduce how much glucose your liver makes, and decrease the amount of sugar your intestines absorb during digestion. 

Ozempic, on the other hand, mimics the natural hormone GLP-1 and stimulates insulin secretion from your pancreas, decreases glucose production in your liver, and slows down gastric emptying. 

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Hypoglycemia

Because these medications work differently, they can sometimes be taken together to help you keep your blood sugar in a healthy range.

Metformin shouldn’t cause your blood sugar to drop, while Ozempic has been known to cause hypoglycemia.

While taking Ozempic, it is a good idea to regularly check your blood sugar while your body adjusts to the medication.

Cost

Metformin and Ozempic are also very different regarding their cost.

Depending on your insurance plan, you may be able to get help covering the cost of your diabetes medications.

However, without insurance, you will notice a dramatic difference in cost. 

Metformin can cost around $4 for 30 tablets, depending on your needed dose.

Ozempic is around $994 for 3 mL. Ozempic does have a savings card available for those who qualify, but overall, Ozempic is much more expensive than metformin. 

Key Similarities of Metformin vs Ozempic

Despite their differences, metformin and Ozempic have several similarities. 

Both of these medications aid in blood sugar management for people with type 2 diabetes.

Neither medication is approved for use in treating type 1 diabetes. 

Metformin and Ozempic have proven themselves to be effective in managing blood sugar levels and lowering HgA1c. 

When it comes to cardiovascular benefits, metformin may reduce the risk of cardiovascular events, and Ozempic has been shown to directly help protect against heart attack and stroke for people with type 2 diabetes and cardiovascular disease. 

Both medications are non-insulin-based and can be taken for long-term diabetes management.

Neither one is designed as a short-term treatment.

By controlling blood sugar levels, you may reduce the risk of long-term complications associated with diabetes. 

How Much Weight Can You Expect to Lose?

Weight loss results are significantly different between metformin and Ozempic. 

Metformin

The weight loss potential for metformin is generally modest.

During clinical trials, some individuals experienced a slight weight reduction, typically ranging from about one to three pounds.

Experts believe this may be due to metformin causing some people to feel nauseous, which may reduce their nutritional intake. 

Ozempic

Ozempic, however, helps people lose significantly more weight.

During clinical studies, people taking Ozempic lost an average of 8 –14 pounds.

It's important to note that participants in the clinical trial used Ozempic as a tool along with following a reduced-calorie diet, and participating in regular exercise.  

Which One is Right for You?

Deciding whether metformin or Ozempic is right for you is a decision you need to make with your care provider as it hinges on several individual factors. 

This choice greatly depends on your specific health needs, including your past medical history, current health conditions, and individual treatment goals. 

Your care team can help you consider potential side effects, the mode of administration, and any existing health concerns like kidney function or heart disease.

Sometimes, metformin and Ozempic are prescribed together. 

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Takeaway

Metformin and Ozempic have unique strengths and considerations for treating type 2 diabetes.

Metformin is a well-established medication.

It’s known for safely and effectively managing blood sugar and has few side effects that are generally quite tolerable.

Metformin is also very affordable compared to other medications.

Ozempic is a newer medication that offers the benefits of blood sugar control, protection against cardiovascular events, and helping people lose excess weight.

Side effects of Ozempic are typically tolerable and tend to disappear.

However, Ozempic carries a high price tag that people without insurance coverage may find prohibitive. 

The choice between the two medications is very personal and should be made in collaboration with your care provider based on your medical history and current health goals. 

How a Dietitian Can Help

A dietitian can help give you personalized advice if you have questions about type 2 diabetes management and are wondering about metformin and Ozempic.

They can give individual guidance on dietary counseling for type 2 diabetes and how each medication may help you.