Tirzepatide is the first drug in a new class of diabetes medications. It is a dual glucose-dependent insulinotropic polypeptide (GIP) and GLP-1 receptor agonist. GLP-1 and GIP are gut hormones called incretins, and the intestines release them when we eat.
Cite this: FDA Approves New Type 2 Diabetes Drug Bexagliflozin - Medscape - Jan 23, 2023.
The newest addition to this drug family combines GLP-1 and another incretin mimic, GIP. Tirzepatide (Mounjaro) was approved for treating type 2 diabetes in May 2022 and tagged for accelerated review for approval to treat obesity, which is anticipated sometime in 2023.
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.
The latest buzzy diabetes drug semaglutide—better known by brand names Ozempic, Wegovy, and Rybelsus—is drawing attention for its ability to both control blood sugar and cause weight loss.
In 2021, these trials revealed that the mean weight loss of patients taking the higher-dose semaglutide was a whopping 14.9 per cent of their body weight over 68 weeks, compared with 2.4 per cent with placebo.
EXPLAINED: Ozempic helps people lose weight. But who should be able to use it? While the drug has become increasingly popular as a weight loss treatment, the TGA says it should only be prescribed for patients with type 2 diabetes.
Medicines containing guanidine, such as metformin and phenformin, were developed to treat diabetes. But they fell out of favor due to serious side effects caused by phenformin, and by the discovery of insulin.
Under certain conditions, too much metformin can cause lactic acidosis. The symptoms of lactic acidosis are severe and quick to appear, and usually occur when other health problems not related to the medicine are present and are very severe, such as a heart attack or kidney failure.
If metformin no longer works for you, your doctor may add another drug to your treatment plan. “But there's no magical second drug; the secondary options will depend on the individual,” she says. Your doctor may prescribe other oral medications or noninsulin injectables.
This in turn lowers blood sugar levels. Metformin has two advantages over other diabetes drugs: There's less risk of your blood sugar level falling too low. It doesn't cause weight gain.
Most experts consider metformin to be the safest medicine for type 2 diabetes because it has been used for many decades, is effective, affordable, and safe.
If your diabetes remains hard to manage even after you begin taking metformin, or you cannot tolerate metformin or do not want to take it, that's when a GLP-1RA or SGLT2i might come in. Studies have shown that both medications are safe and effective at lowering blood glucose when compared to a placebo.
Mounjaro (tirzepatide), Ozempic (semaglutide), and Trulicity (dulaglutide) are examples of diabetes medications that can cause significant weight loss. Metformin and Jardiance (empagliflozin) may also cause weight loss but not as much.
While metformin is a more common first-choice medication for Type 2 diabetes, weight loss is more likely with Ozempic. Ozempic can also lower your risk of heart attack and stroke if you have diabetes and heart disease. And it has been shown to have potential benefits for the kidneys.
If you eat a lot of sugar while taking Metformin, your body will have to work harder to keep your blood sugar levels within a healthy range, and the Metformin will not be as effective for weight loss. However, if it happens infrequently, you should not suffer too many negative side effects. The key is moderation.
High-Fiber Foods
Researchers posit that exceeding 30 grams of fiber in a day may lower metformin levels in the body due to the fact that fiber binds to the drug and reduces its efficacy. (9) So it may be best to avoid high-fiber foods like oatmeal, chickpeas, avocado, berries, peas, beans, and chia seeds.
Metformin is often a first-choice treatment for Type 2 diabetes. It's not known to be harmful to your kidneys or other organs. But if you have kidney problems, there's a greater risk of a serious condition called lactic acidosis. Your healthcare provider should watch your kidney function while you're taking metformin.
How long to take it for. Treatment for diabetes is usually for life. But if your kidneys are not working properly, your doctor will tell you to stop taking metformin and switch you to a different medicine. Do not stop taking metformin without talking to your doctor.
But Ozempic's rise to superstardom status was not something most people predicted. In fact, the drug was created by Novo Nordisk to help diabetes patients control their blood sugar. But the drug's side effect of rapid weight loss quickly stole headlines and made Ozempic a very hot commodity.
Semaglutide, which is taken as a weekly injection that is self-administered, helps people with type 2 diabetes to control their blood sugar and in many cases also lose weight.
Mounjaro - also known by its generic name tirzepatide - is the newer kid on the block. Like Ozempic and Wegovy, it suppresses the appetite and lengthens the amount of time food stays in the stomach, leading to weight loss - at least for as long as you carry on taking it.