Metformin is a frequently prescribed medication for managing type 2 diabetes, and it is also the most prescribed drug globally. It may not be appropriate for all individuals. Certain people might encounter side effects or have conditions that require the consideration of other options.

Let us help you know about the two types of diabetes that a person can face: type 1 and type 2 diabetes. Both are considered chronic diseases that will act on glucose production and the sugar you need.

Glucose is the foremost thing your body cells need, so Insulin is critical.

  • People who have type 1 diabetes don’t develop Insulin in the body.
  • For people with type 2 diabetes, glucose does not react to Insulin as it should.

These two types of diabetes have harmful effects on the body and can increase blood sugar levels. Although there are many type-2 diabetic drugs, patients would be offered Metformin alternatives according to the national guidance on managing type-2 diabetes.

8 Best Metformin Alternatives For Type 2 Diabetes

Thankfully, numerous alternative medications and lifestyle adjustments can be just as effective. Other oral medicines considered alternatives to Metformin include sulfonylureas, meglitinides, thiazolidinediones, DPP-4 inhibitors, and SGLT2 inhibitors. Every one of these options functions differently to regulate blood sugar levels and comes with a range of possible side effects and factors to consider.

1. Modified-release Metformin Alternative To Standard Metformin

Modified-release Metformin, often referred to as MR Metformin, is a viable alternative to standard Metformin, particularly for those who experience gastrointestinal side effects from the latter. This alternative medication is designed to slowly release the active ingredient, Metformin, over a prolonged period, which can help minimize these side effects. Both versions of the drug are used to manage type 2 diabetes, working to control blood sugar levels and improve the body’s response to Insulin.

Popular modified-release Metformin brands:

  • Sukkarto SR
  • Glucophage SR
  • Yaltormin SR

The management of type 2 diabetes is outlined in the NICE guide for healthcare professionals (NICE, 2020). The guide highlights three primary classes of drugs recommended as treatment alternatives.

  • Dipeptidyl peptidase 4 (DPP 4)
  • inhibitor (gliptins)
  • pioglitazone
  • sulfonylurea

However, it’s important to note that while MR Metformin may offer particular advantages over its standard counterpart, it may not be suitable for everyone. As with any medication change, patients must consult their healthcare provider before switching to ensure it’s the right choice for their health needs and circumstances.

2. Sulfonylurea Type 2 Diabetic Drugs

Sulfonylurea drugs, a class of oral hypoglycemic agents, have been widely used as an alternative to Metformin in the management of type 2 diabetes. These medications function by stimulating the beta cells in the pancreas to release more Insulin, thereby helping to control blood glucose levels.

Sulfonylureas, which include drugs such as:

  • Glipizide
  • Glyburide
  • Glimepiride

These are often prescribed when lifestyle modifications and Metformin alone are insufficient in managing blood sugar levels.

While they have proven effective in controlling hyperglycemia, Sulfonylureas have potential side effects, including hypoglycemia and weight gain. It’s also worth noting that these drugs may not be suitable for all patients with type 2 diabetes, particularly those with kidney disease or certain genetic conditions. Therefore, while Sulfonylureas can be a viable alternative to Metformin for some patients, healthcare providers must consider individual patient factors and potential risks when determining the most appropriate treatment plan.

3. Dipeptidyl Peptidase IV (DPP IV) Inhibitors

Gliptins, also known as DPP-4 inhibitors, have emerged as a viable alternative to Metformin for managing type 2 diabetes. These oral antidiabetic drugs work by blocking the action of DPP-4, an enzyme that destroys the hormone incretin. Like a clinical researcher, incretins assist in regulating insulin production based on the body’s needs and decrease the liver’s glucose production when unnecessary. This mechanism of action is different from Metformin, which primarily reduces glucose production by the liver and increases its uptake by the muscles. Gliptins are generally well-tolerated and have a lower risk of causing hypoglycemia compared to other antidiabetic drugs. They can be used alone or in combination with other medications to effectively control blood sugar levels in patients with type 2 diabetes.

DPP IV Inhibitors, which include drugs such as:

  • sitagliptin
  • saxagliptin
  • linagliptin
  • alogliptin

However, like all medications, Gliptins come with their own set of potential side effects and may not be suitable for everyone. Therefore, healthcare providers must consider each patient’s unique medical history, lifestyle factors, and personal preferences when deciding whether to prescribe Gliptins as an alternative to Metformin.

4. Meglitinides

Meglitinides are a class of diabetic drugs that serve as an alternative to Metformin, a commonly prescribed medication for type 2 diabetes. These drugs, which include repaglinide and nateglinide, work by stimulating the pancreas to release Insulin, thereby helping to control blood sugar levels. Unlike Metformin, which primarily reduces glucose production by the liver and improves insulin sensitivity, meglitinides act quickly, and their effect is short-lived. This makes them particularly effective for controlling post-meal blood sugar spikes.

Meglitinides, which include drugs such as:

  • repaglinide
  • nateglinide
  • mitiglinide

However, they also carry a risk of causing hypoglycemia or low blood sugar, especially if a meal is skipped after taking the medication. As with any medication, the potential benefits and risks must be weighed carefully, and patients need to discuss these factors with their healthcare provider before deciding. Meglitinides may be an appropriate choice for some individuals with type 2 diabetes, particularly those who struggle with post-meal hyperglycemia or who have contraindications to Metformin. However, they are typically used when other first-line treatments are ineffective or not tolerated.

5. Thiazolidinediones (TZDs)

Thiazolidinediones, often referred to as TZDs, are a class of oral antidiabetic drugs that have emerged as a viable alternative to Metformin for the management of type 2 diabetes. These medications function by reducing insulin resistance in the body, thereby enhancing the efficacy of Insulin already present. The primary members of this drug class include Pioglitazone and Rosiglitazone. While Metformin remains the first-line treatment for type 2 diabetes due to its proven effectiveness and Safety profile, TZDs can be considered in cases where Metformin is contraindicated or not tolerated by the patient.

TZDs, which include drugs such as:

  • rosiglitazone
  • pioglitazone

However, it’s important to note that, like all medications, TZDs also come with their own set of potential side effects and risks, including weight gain and an increased risk of heart failure. Therefore, the decision to use Thiazolidinediones should be made individually, considering the patient’s overall health status, lifestyle factors, and personal preferences.

6. Sodium-glucose cotransporter-2 (SGLT2) inhibitors

Sodium-glucose cotransporter-2 (SGLT2) inhibitors have emerged as a viable alternative to Metformin for managing diabetes. These drugs, which include canagliflozin, dapagliflozin, and empagliflozin, work by blocking glucose reabsorption in the kidneys, thereby promoting its excretion in urine and reducing blood glucose levels. Unlike Metformin, which primarily works by decreasing the liver’s production of glucose and improving insulin sensitivity, SGLT2 inhibitors offer a unique mechanism of action that can be beneficial for patients who cannot tolerate Metformin or for whom Metformin alone is insufficient to control their blood sugar levels. Moreover, SGLT2 inhibitors have been associated with additional health benefits such as weight loss and reductions in blood pressure and cardiovascular risk.

SGLT2 inhibitors, which include drugs such as:

  • Dapagliflozin
  • Canagliflozin
  • Dapagliflozin
  • Ertugliflozin

However, like all medications, they also carry potential risks and side effects that need to be considered in the context of each patient’s health status and treatment goals. Therefore, while SGLT2 inhibitors represent a promising alternative to Metformin, their use should be guided by a comprehensive evaluation of the patient’s overall health profile and therapeutic needs.

7. glucagon-like peptide-1 receptor agonists (GLP-1 Agonists)

GLP-1 Agonists, or glucagon-like peptide-1 receptor agonists, are diabetic drugs that have emerged as a viable alternative to Metformin for managing type 2 diabetes. These medications mimic the functions of the body’s natural GLP-1 hormone, which regulates blood sugar levels. They stimulate the pancreas to produce Insulin when blood glucose levels are high and reduce the amount of glucose released by the liver. Unlike Metformin, GLP-1 Agonists also slow down digestion, which helps to decrease appetite and promote weight loss – a significant advantage for individuals with type 2 diabetes who are also struggling with obesity.

GLP-1 Agonists, which include drugs such as:

  • Dulaglutide
  • Exenatide
  • Exenatide
  • Semaglutide
  • Liraglutide
  • Lixisenatide
  • Lixisenatide

However, it’s important to note that while GLP-1 Agonists can be an effective alternative, they may not be suitable for everyone due to potential side effects and individual health considerations. Therefore, patients must discuss all treatment options with their healthcare provider to determine the best course of action for their specific needs and circumstances.

8. LifeStyle Changes

Research has shown that restricting calorie intake can lead to remission from type 2 diabetes. Based on the twin cycle hypothesis, an accumulation of fat in the liver can result in an increased fat supply in the pancreas, leading to impaired functioning of these organs.

The pancreas produces Insulin, which is crucial in regulating sugar levels within the body. Reducing calorie intake can effectively decrease glucose production and achieve weight loss.

The duration of the condition plays a vital role in determining the success of remission from diabetes. Individuals with type 2 diabetes for less than four years experienced a rapid decrease in blood glucose levels.

In contrast, a calorie-restricted diet was found to only achieve normal sugar levels in 50% of patients with type 2 diabetes who had been diagnosed for 8 years or longer.

How To Switch On Metformin Alternative?

If, for any reason, you are seeking an alternative medication to Metformin, it is essential to avoid abruptly discontinuing Metformin and switching to another drug without proper consideration. First, seeking guidance from a certified family doctor or medical professional is advisable. Stopping Metformin suddenly can result in elevated blood sugar levels. It is essential to avoid abruptly discontinuing medication unless it is causing side effects or allergic reactions. It is important to remember that any changes to the alternative should be implemented gradually and carefully. Therefore, it is essential to plan your treatment carefully.

Final Words Form AzDrug

There are several alternative drugs available for patients who are unable to tolerate or take Metformin. For individuals experiencing bothersome gastrointestinal side effects, a modified-release form of Metformin may be a suitable initial treatment option.

This post shows that several alternatives to Metformin can lead to gastrointestinal side effects similar to those caused by Metformin. Implementing a healthy lifestyle, including regular exercise and mindful eating, can substantially impact managing blood sugar levels. Treatment decisions are made by considering the unique circumstances of each patient.

Also Read:

Disclaimer: Please see your healthcare practitioner for any medical queries or concerns. Peer-reviewed research and information from medical societies and government agencies are used to support the articles in Health Guide. They are not, however, a replacement for expert medical advice, diagnosis, or treatment.

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