The Best Alternatives to Metformin for Type 2 Diabetes Management

Metformin is a well-liked prescription drug that’s used as a first-line remedy for sort 2 diabetes. 

For almost all of customers, metformin is efficient and well-tolerated. However in case you are experiencing extreme or persistent unwanted side effects when taking this drugs, or if it merely isn’t working, chances are you’ll marvel if there are another choices.

The reply is sure. This text will examine the most effective alternate options to metformin for individuals with sort 2 diabetes. 

Why would you not take metformin?

Metformin helps higher handle blood sugar ranges, combat insulin resistance (a situation by which the physique doesn’t use insulin effectively), and may even assist with weight reduction. Most tips suggest it because the first-line remedy for sort 2 diabetes. 

It is usually very reasonably priced and customarily efficient, however that effectiveness can include a price: unwanted side effects. 

Unintended effects

Metformin may cause a wide range of doubtlessly detrimental unwanted side effects, together with:

For some individuals who have strict work or faculty schedules, enduring a few of these unwanted side effects will not be attainable. 

Moreover, experiencing these unwanted side effects also can affect different areas of your life. Coping with power gastrointestinal points, for instance, can grow to be an impediment to consuming nicely or forestall you from sustaining an everyday train behavior. 

Contraindications

In different instances, individuals could keep away from taking metformin as a result of it’s contraindicated (not suggested) to take with many different widespread prescribed drugs. (Right here is an summary of the medicine that will work together with metformin.) 

Generally it’s inconceivable to cease taking one other drugs that negatively interacts with metformin, and subsequently, a substitute is important. 

Ineffectiveness

And for some individuals, metformin merely isn’t efficient. It doesn’t assist everybody higher handle their blood sugars, decrease their HbA1c ranges (a measure of glucose management over the earlier 2 to three months), or drop pounds. Actually, some individuals even achieve weight when taking metformin.

Insurance coverage or life-style issues

Lastly, some individuals could choose to not take metformin as a result of their medical insurance doesn’t cowl it, or they want to handle their diabetes with out using prescription drugs. 

What are alternate options to metformin? 

The next are some alternate options that you would be able to focus on along with your physician.

(Keep in mind to at all times work along with your healthcare supplier earlier than making any modifications to your diabetes administration.) 

Sulfonylureas 

Sulfonylureas are oral diabetes drugs which can be usually taken with or earlier than a meal. They work to decrease blood sugar by rising the manufacturing of insulin from the beta cells within the pancreas. These tablets are often both taken as soon as a day earlier than breakfast or twice every day, earlier than each breakfast and dinner. 

Sulfonylureas embrace:

• Glipizide (model identify Glucotrol)
• Glimepiride (Amaryl)
• Glyburide (Diabeta, Glynase)

Sulfonylurea unwanted side effects

Some attainable unwanted side effects embrace: 

Thiazolidinediones (TZDs)

TZDs are an oral class of sort 2 diabetes treatment that will increase insulin sensitivity and helps lower glucose manufacturing by the liver.

They’re simply accessible and reasonably priced and should not have a excessive threat of inflicting hypoglycemia.

Thiazolidinediones embrace:

• Pioglitazone (Actos)
• Rosiglitazone (Avandia)

Thiazolidinedione unwanted side effects

Some attainable unwanted side effects embrace:

• Weight achieve
• Elevated threat for coronary heart illness
• Edema (swelling) of toes, legs, arms, and palms 
• Elevated threat for bone fracture 

DPP-4 inhibitors 

DPP-4 inhibitors decrease blood sugar and HbA1c ranges with out inflicting low blood glucose (until taken with different medicines that may trigger hypoglycemia, similar to insulin or sulfonylureas).

They operate by interfering with the breakdown of two hormones within the physique, GLP-1 and GIP, that cut back blood glucose ranges. 

These hormones are usually damaged down in a short time. By serving to gradual this course of, DPP-4 inhibitors permit the hormones to operate for longer, reducing blood sugar ranges solely when they’re elevated.

These medicine are taken orally, typically together with metformin, however they are often taken with out metformin as nicely. 

DPP-4 inhibitors embrace:

• Sitagliptin (Januvia)
• Saxagliptin (Onglyza)
• Linagliptin (Tradjenta)
• Alogliptin (Nesina)

DPP-4 inhibitor unwanted side effects

Attainable unwanted side effects embrace:

• Low blood sugar, if taken together with insulin or sulfonylureas
• Gastrointestinal points like upset abdomen 
• Elevated threat for pancreatitis (irritation of the pancreas)
• Fever, physique aches, and different flu-like signs 

GLP-1 receptor agonists 

GLP-1 receptor agonists can both be taken orally or by an injection (both as soon as a day or as soon as weekly), relying on the precise drugs used. They operate equally to the GLP-1 and GIP hormones within the physique that decrease insulin ranges however are extra immune to being damaged down. 

Along with reducing blood sugar and HbA1c ranges, a few of these medicines additionally defend towards coronary heart illness. 

Notably, though they aren’t weight-loss medicine, GLP-1 receptor agonists can assist with weight reduction. In response to the Mayo Clinic, research point out that each one GLP-1 medicine can result in a complete weight lack of between 10.5 and 15.8 kilos. 

GLP-1 receptor agonists embrace:

GLP-1 receptor agonist unwanted side effects

Attainable unwanted side effects embrace:

• Nausea 
• Vomiting
• Low blood sugar ranges (if taken together with insulin)
• Decreased want for insulin, if on insulin remedy 
• Diarrhea 
• Weight reduction 

SGLT-2 inhibitors 

SGLT-2 inhibitors are a category of oral treatment, usually taken every day, used to decrease blood sugar ranges and HbA1c ranges by inflicting the discharge of extra glucose within the urine. They not often trigger low blood sugar.

These drugs can defend towards coronary heart failure and enhance outcomes in individuals who have coronary heart illness, kidney illness, or coronary heart failure.

SGLT-2 inhibitors embrace:

SGLT-2 inhibitor unwanted side effects

Attainable unwanted side effects embrace:

• Frequent urination
• Elevated frequency of urinary tract infections (UTIs) 
• Elevated threat for kidney harm
• Elevated threat for diabetic ketoacidosis (DKA)
• Dehydration
• Thirst
• Low blood stress 
• For Invokana, particularly, elevated threat of amputations 

GIP/GLP-1 receptor agonists

The primary drugs on this class was authorised in 2022. It’s an injectable drug taken as soon as weekly, and it capabilities by mimicking the actions of each GLP-1 and GIP to assist decrease blood sugar ranges. 

Analysis signifies that this treatment results in a median weight lack of about 15 % to twenty %.

GIP/GLP-1 receptor agonists embrace:

GIP/GLP-1 receptor agonist unwanted side effects

Attainable unwanted side effects embrace:

• Gastrointestinal points
• Hypoglycemia, notably when used with one other drugs that may trigger low blood sugar similar to a sulfonylurea or insulin
• Weight reduction
• Pancreatitis
• Adjustments in ldl cholesterol and triglyceride ranges
• Kidney points
• Fatigue and dizziness

Insulin

Insulin has been a cornerstone in diabetes remedy since its discovery in 1921. In sort 2 diabetes, it’s typically used when different medicines don’t present satisfactory blood sugar management. 

The aim of insulin remedy is to imitate the physique’s pure insulin manufacturing. It’s administered by way of injection, infusion (from an insulin pump), or inhalation. The various kinds of insulin range in onset, peak occasions, and period of motion. 

A number of the extra widespread insulins utilized in the US embrace:

Speedy-acting insulin

• Insulin lispro (Humalog, Admelog)
• Insulin aspart (NovoLog, Fiasp)
• Insulin glulisine (Apidra)

Quick-acting insulin

• Common human insulin (Humulin R, Novolin R)

Intermediate-acting insulin

• NPH (isophane) insulin (Humulin N, Novolin N)

Lengthy-acting insulin

• Insulin glargine (Lantus, Basaglar, Toujeo)
• Insulin detemir (Levemir)
• Insulin degludec (Tresiba)

Attainable unwanted side effects 

• Hypoglycemia, notably if the insulin dose isn’t balanced with meals consumption and bodily exercise
• Weight achieve
• Adjustments in fats tissue at injection websites
• Allergic reactions, starting from native injection web site reactions to systemic ones
• Swelling of legs and arms
• Insulin resistance, particularly with larger doses over time

Much less-commonly used alternate options

Alpha-glucosidase inhibitors

The starches you eat are damaged down into sugars by your physique. Alpha-glucosidase inhibitors assist decrease blood sugar ranges by blocking the digestion of starches. They’re taken with the primary chew of every meal.

Alpha-glucosidase inhibitors embrace:

• Precose (generic solely)
• Miglitol (Glyset)

Alpha-glucosidase inhibitor unwanted side effects

Frequent unwanted side effects embrace: 

• Gastrointestinal points similar to gasoline and diarrhea

Meglitinides

Meglitinides are a kind of oral treatment that stimulates the insulin-producing beta cells of the pancreas to launch insulin. They’re taken earlier than every meal to assist decrease after-meal blood glucose ranges.

Meglitinides embrace:

• Repaglinide (Prandin)
• Nateglinide (Starlix)

Meglitinide unwanted side effects

Frequent unwanted side effects embrace: 

Way of life modifications 

Lastly, adopting wholesome life-style modifications is at all times method, whether or not or not you take treatment. Participating in common bodily exercise and consuming a balanced, nutritious weight loss program can assist handle blood sugar ranges, decrease your HbA1c, and doubtlessly result in weight reduction as nicely. 

This can be the most cost effective possibility, however it may be laborious to keep up. And it’s additionally not assured that life-style modifications will can help you cease taking drugs. 

Different elements, similar to a genetic predisposition for diabetes, could make treatment needed, even in case you are in nice bodily situation and in any other case wholesome. 

Speak along with your physician and meet with a registered dietitian (RD) to develop an train and consuming plan that can work to your life-style and well being targets. 

Last ideas

Whereas metformin is an especially standard, reasonably priced, and accessible drug for sort 2 diabetes administration, it isn’t for everybody. 

Some individuals expertise debilitating unwanted side effects that make taking this drug over the long run inconceivable. Others could not have insurance coverage protection for metformin or could not want to take extra medicines, or metformin could merely not be working for them. 

Luckily, different choices can be found. Drug lessons together with sulfonylureas, thiazolidinediones, DPP-4 inhibitors, GLP-1 receptor agonists, SGLT-2 inhibitors, GIP/GLP-1 receptor agonists, and fewer widespread alternate options like alpha-glucosidase inhibitors and meglitinides can be utilized to deal with sort 2 diabetes.

Adopting wholesome life-style approaches similar to elevated bodily exercise and a nutritious weight loss program also can assist, whether or not or not you’re taking drugs.

Do a little analysis to see what your medical insurance will cowl to make it possible for any modifications in your diabetes drugs are financially sustainable over the long run. 

If metformin isn’t working nicely and also you wish to make a change, converse along with your physician about attainable alternate options, and focus on what’s going to work finest for you, your life-style, and your well being targets.