Is Rybelsus Better Than Metformin For Treating Type 2 Diabetes?

Understanding Rybelsus and Metformin

Diabetes is a chronic condition that affects how the body processes blood sugar (glucose). Over time, high blood sugar levels can damage organs and lead to complications like heart disease, kidney damage, vision loss, and nerve problems.

There are several types of diabetes medications that work in different ways to lower blood sugar. Two common options are Rybelsus and metformin.

What is Rybelsus?

Rybelsus is a brand name prescription medication used to improve blood sugar levels in adults with type 2 diabetes. It contains the active drug semaglutide and belongs to a class of diabetes medications called GLP-1 receptor agonists.

Rybelsus comes as a pill that is taken once daily. It works by stimulating the release of insulin when blood sugar levels are high. It also slows digestion and decreases appetite, which can lead to weight loss.

What is Metformin?

Metformin is an oral diabetes medication that has been used for decades to treat type 2 diabetes. Brand names for metformin include Glucophage, Glumetza, and others.

Metformin belongs to a class of medications called biguanides. It works by reducing the amount of glucose released by the liver and making the body’s cells more sensitive to insulin. This allows insulin to work better and lower blood glucose levels.

Metformin is usually taken twice per day with meals. It can cause gastrointestinal side effects like nausea and diarrhea in some people.

Comparing Rybelsus vs. Metformin

Rybelsus and metformin are both oral diabetes medications, but they work in different ways. Here is an overview of how Rybelsus compares to metformin:

Effectiveness

Studies have found that Rybelsus and metformin are similarly effective at lowering A1C, which is a measure of average blood sugar levels over 2-3 months.

In a clinical trial, Rybelsus lowered A1C by up to 1.3% compared to placebo. Metformin can lower A1C by 1-2% on its own.

Rybelsus may have an additional benefit for weight loss. People taking Rybelsus lost up to 12 pounds over 26 weeks compared to 2 pounds with placebo.

Side Effects

The most common side effects of Rybelsus include nausea, diarrhea, vomiting, decreased appetite, and constipation. These tend to be mild or moderate.

Metformin can also cause GI side effects like diarrhea, nausea, gas, and abdominal discomfort. These occur in about 5-10% of users.

Rybelsus has a risk of thyroid tumors, including thyroid cancer. It carries an FDA warning about this risk. Metformin does not appear to increase this risk.

Cost and Availability

Rybelsus is a brand name drug, so it is often more expensive than generic options. Metformin is available as a low-cost generic.

Without insurance, Rybelsus can cost over $1000 per month. Metformin can cost as little as $10-25 per month.

Metformin is available as a generic, while Rybelsus is only available as a brand name. Rybelsus may not be covered by some insurance plans or Medicare/Medicaid.

Who Might Do Better With Rybelsus or Metformin?

Rybelsus and metformin are both good options for treating type 2 diabetes. There are some factors that might make one medication a better choice than the other for some patients:

Candidates for Rybelsus

Need help losing weight along with lowering blood sugar
Prefer taking medication by mouth rather than injection
Have GI side effects like diarrhea with metformin
Need more than 1.5-2% reduction in A1C
Want an oral medication option other than metformin

Candidates for Metformin

Need an affordable generic diabetes medication
Have kidney problems (metformin is usually preferred here)
Are at increased risk for thyroid cancer
Don't want to take an injectable medication
Are newly diagnosed with diabetes or have milder A1C elevations

Using Rybelsus and Metformin Together

Rybelsus and metformin work well together. Combining them provides complementary effects on blood sugar levels and may give better control than either medication alone.

Taking Rybelsus with metformin allows people to use lower doses of each medication. This can decrease side effects like nausea or diarrhea compared to higher doses of either drug.

The combination takes advantage of the different mechanisms of these two medications. Metformin reduces glucose production by the liver while Rybelsus improves insulin secretion and sensitivity.

Dosing when Used Together

The typical dosing when combining Rybelsus with metformin is:

Metformin - start at 500 mg twice per day. Increase by 500 mg weekly up to 2000 mg per day.
Rybelsus - start at 7 mg daily for 30 days. May increase to 14 mg daily if needed.

Rybelsus should be taken at least 30 minutes before the first meal of the day. Metformin is normally taken with meals to reduce GI side effects.

Frequently Asked Questions

Is Rybelsus better for weight loss than metformin?

Yes, Rybelsus appears to be more beneficial for weight loss than metformin. In studies, Rybelsus users lost significantly more weight over 6 months compared to metformin or placebo.

Does Rybelsus cause hypoglycemia?

When used alone, Rybelsus has a low risk of causing hypoglycemia (low blood sugar). The risk may be higher when it is combined with medications like insulin or sulfonylureas.

Can metformin be stopped when starting Rybelsus?

It’s usually recommended to keep taking metformin when starting Rybelsus rather than stopping metformin. The combination provides better blood sugar control with fewer side effects than either drug alone.

How long does it take for Rybelsus to work?

Rybelsus starts lowering blood sugar within the first 1-2 weeks, but the full effects may take up to 3 months. A1C reductions are seen after about 3 months of treatment.

Should Rybelsus be taken with food?

No, Rybelsus should be taken on an empty stomach at least 30 minutes before the first meal of the day. Taking it with food can decrease the medication's absorption.

The Bottom Line

Both Rybelsus and metformin are effective medications for managing type 2 diabetes. Rybelsus is a newer oral GLP-1 drug that can promote weight loss, while metformin is an affordable generic option with a long track record.

Rybelsus may be a good choice for people who have not reached their target A1C on metformin alone or need extra help losing weight. Using Rybelsus and metformin together is an effective combination approach.

Talk to your doctor about whether Rybelsus or metformin is right for your diabetes management and health goals.

FAQs

Is Rybelsus an insulin?

No, Rybelsus is not insulin. It belongs to a class of medications called GLP-1 receptor agonists. Rybelsus helps stimulate insulin production and improves insulin sensitivity but does not actually contain insulin.

What are the side effects of Rybelsus?

Common side effects of Rybelsus include nausea, vomiting, diarrhea, decreased appetite, constipation, and stomach pain. Rybelsus may also increase the risk of thyroid tumors or thyroid cancer.

Can I take Rybelsus if I have kidney problems?

Rybelsus has not been well studied in people with severe kidney impairment. It may be used cautiously in those with mild to moderate kidney disease. Dose adjustments are not needed.

How much weight can you lose on Rybelsus?

In clinical trials, people taking Rybelsus lost between 6-12 pounds over 6 months compared to those taking placebo. Weight loss results vary between individuals.

When is the best time to take Rybelsus?

Rybelsus should be taken every morning at least 30 minutes before eating breakfast or your first meal. Taking it at this time gives the best blood sugar lowering effects.

Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult with a healthcare professional before starting any new treatment regimen.