If you’ve been diagnosed with type 2 diabetes or are struggling to manage your blood sugar, you’ve probably heard about metformin and Ozempic. Both are effective, but they work differently and offer unique benefits. So which one is the better choice for you? The answer depends on your health goals, lifestyle, and how your body responds to treatment.

At Genesis Lifestyle Medicine, we understand that every patient is different. That’s why we take a personalized, science-based approach to help you make the most informed decision about your health. In this article, we’ll break down how metformin and Ozempic work, compare their effectiveness and side effects and explain when combining the two might offer the best results.

What are metformin and Ozempic?

Metformin

Metformin is one of the most widely prescribed medications for type 2 diabetes. It belongs to a class of drugs called biguanides and is usually taken by mouth once or twice daily. Metformin works by lowering the amount of glucose your liver produces, increasing your body’s sensitivity to insulin, and slowing down the absorption of sugar from the food you eat. Metformin is often recommended as a first-line treatment for newly diagnosed type 2 diabetes patients. 

Ozempic

Ozempic, or semaglutide, is a newer medication classified as a GLP-1 receptor agonist. It’s administered as a once-weekly injection under the skin. Ozempic helps lower blood sugar by increasing insulin release, decreasing the amount of sugar your liver produces, and slowing digestion—which makes you feel fuller for longer and naturally reduces your appetite. Ozempic has also gained attention for its effectiveness in supporting weight loss.

How they lower blood sugar

Metformin

Metformin lowers blood sugar by targeting the liver. It reduces the amount of glucose your liver produces and improves your cells’ ability to use insulin more efficiently. It does not directly stimulate insulin release, which helps reduce the risk of low blood sugar (hypoglycemia).

Ozempic

Ozempic lowers blood sugar by mimicking a natural hormone called GLP-1. It triggers your pancreas to release insulin when you eat and slows digestion to prevent post-meal blood sugar spikes. This makes Ozempic suitable for those needing more than just baseline blood sugar control.

Weight loss potential

Metformin

While not a weight-loss drug, metformin may lead to modest weight loss in some individuals. Clinical studies have shown that patients taking metformin lost about 1.4 pounds over 29 weeks and up to 6.4 pounds over five years. However, weight changes are often minimal and vary depending on your lifestyle and other medications.

Ozempic

Ozempic has shown significant weight loss benefits, especially at higher doses. In a 30-week clinical trial:

• Patients taking 0.5 mg lost an average of 8.3 pounds
• Patients taking 1 mg lost an average of 10.3 pounds
• Placebo users lost only 2.6 pounds

Its ability to suppress appetite and slow digestion makes it a more targeted choice for those also struggling with obesity or weight-related health issues.

Side effects and risks

Metformin

The most common side effects of metformin are digestive-related, including:

• Diarrhea
• Nausea
• Gas or bloating
• Stomach discomfort

A rare but serious risk associated with metformin is lactic acidosis, a condition caused by the buildup of lactic acid in the bloodstream. While extremely rare, it’s something your provider will monitor for if you’re at risk.

Ozempic

Ozempic can also cause gastrointestinal issues, such as:

• Nausea
• Vomiting
• Constipation
• Stomach pain

In rare cases, Ozempic has been linked to pancreatitis and ileus (a blockage in the intestine). Your provider will assess your medical history to ensure that Ozempic is both safe and appropriate for your needs.

Combining both metformin and Ozempic

Yes, you can take metformin and Ozempic together—and for many patients, this combination is highly effective. Because they work in different ways, using both can offer better blood sugar control and greater weight loss than either medication alone.

In fact, during the FDA approval process, many participants in Ozempic studies were also taking metformin. If your blood sugar isn’t well managed with one medication alone, your Genesis provider may recommend adding the other to your plan.

Which is better: metformin or Ozempic?

The best choice depends entirely on your goals and your body’s needs:

• If you're newly diagnosed with type 2 diabetes and are looking for an affordable, time-tested option, metformin may be the right starting point.
• If you’re struggling with excess weight (being overweight or obese) or need additional support managing your blood sugar, Ozempic could offer the edge you need.
• And in many cases, using both together offers the best of both worlds.

At Genesis Lifestyle Medicine, we don’t believe in one-size-fits-all treatment plans. Our team takes time to understand your unique health profile, lifestyle, and goals to design a personalized program that truly works for you. Reach out today to schedule your consultation, explore your options, and find the right treatment.