Metformin vs Wegovy: Which medication is right for you?

Key points

• Metformin treats type 2 diabetes; Wegovy does not
• Wegovy (semaglutide) is approved for weight loss and reducing heart/liver disease risk
• Wegovy may help diabetes indirectly via weight loss, but Ozempic (also semaglutide) is the approved type 2 diabetes medication
• Metformin is affordable with generics and widespread insurance coverage. Wegovy is more expensive, with no generics and variable coverage

Metformin has been the go-to diabetes medication for decades. Wegovy and Ozempic represent a different class of drugs: newer drugs designed for greater weight loss and blood sugar control.

While these medications sometimes get lumped together, they actually do very different things in your body.

This guide breaks down exactly what Metformin and Wegovy do, how much they cost, and which health conditions they actually treat, so you can walk into your doctor's office prepared with the right questions.

Metformin vs. Wegovy? Which one is better for diabetes?

About metformin

Metformin is the gold standard for treating type 2 diabetes. It's typically the first medication doctors prescribe when someone is diagnosed with type 2 diabetes. It’s been around for over 60 years and was introduced to the United States in the mid-1990s.

So, it has years of history behind it, and helps manage blood sugar levels in both adults and children with type 2 diabetes.

Studies show that metformin can reduce hemoglobin A1C (a measure of average blood sugar over three months) by about 1.1-1.2% over 12 months.

About Wegovy

Wegovy (semaglutide) is not approved to manage blood sugar levels or type 2 diabetes. It is a weight loss drug approved for adults and children aged 12 and older who have obesity. Adults who are overweight with at least one weight-related health condition (like high blood pressure or high cholesterol) can also use Wegovy.

People taking Wegovy may notice their A1C levels drop as a beneficial side effect.

Gia Eapen, MD, explains: "Semaglutide, the star ingredient in Wegovy, signals the pancreas to release insulin when you start eating. This process helps stabilize blood sugar. Plus, losing weight (with Wegovy’s help) improves insulin resistance and blood sugar control. So, Wegovy indirectly also helps stabilize blood glucose levels.”

However, there are other options, such as Ozempic and Rybelsus.

Wegovy alternatives for type 2 diabetes

“If someone needs semaglutide specifically for diabetes management, Ozempic and Rybelsus are FDA-approved for that purpose," explains Gia Eapen, MD. “Mounjaro, which contains tirzepatide, is another medication approved for type 2 diabetes. Talk to your healthcare provider to determine what's appropriate for your condition."

Metformin vs. Wegovy: How do they work?

How does metformin work?

Metformin (dimethyl-biguanide) controls blood sugar in a few ways:

• It tells your liver to stop releasing too much glucose: Your liver naturally stores and releases glucose, but in type 2 diabetes, it may go into overdrive. Metformin slows this process down
• Metformin helps muscle and fat cells respond better to insulin: Think of insulin as a key that unlocks cells so glucose can enter. In type 2 diabetes, those locks get rusty. Metformin helps them function better, so your cells can absorb glucose
• Metformin reduces the amount of sugar absorbed from food: This way, less glucose enters your bloodstream after meals

These effects work together to lower blood sugar throughout the day. Unlike medications that force your body to produce more insulin, metformin helps your body use its own insulin more effectively.

How does Wegovy work?

Wegovy (semaglutide) is called a GLP-1 receptor agonist because it mimics the actions of GLP-1, a hormone naturally produced in your body.

Wegovy performs many important functions:

• When your blood sugar goes up, it signals your pancreas to release insulin
• It keeps food in your stomach longer, creating a fuller feeling that lasts
• It also sends signals to your brain to help reduce hunger and food cravings

Wegovy targets multiple systems in the body at the same time. This helps people eat less, feel satisfied with smaller portions, and lose weight.

Metformin vs. Wegovy: How are they administered?

Ozempic and Rybelsus contain the same active ingredient as Wegovy: semaglutide. All three work similarly. Wegovy and Ozempic are weekly injections, while Rybelsus is a daily pill.

How to take metformin?

Metformin is an oral medication available in two forms. The immediate-release version is taken twice daily with meals.

The extended-release version is taken once daily with the evening meal. Your doctor will determine the right dose, typically between 500 mg and 2,550 mg per day.

How to take Wegovy?

Wegovy is a once-weekly injection given under the skin. The pre-filled pen makes self-injection straightforward.

The starter dose is typically a low 0.25 mg weekly. The dose can be increased gradually over several weeks until reaching a maintenance dose of 1.7 mg or 2.4 mg weekly. This gradual increase helps the body adapt and lowers the risk of side effects.

Note: Ozempic is also a once-weekly injection. Rybelsus is taken as a daily oral tablet.

Metformin vs. Wegovy? Which one is better for weight loss?

If you are looking for weight loss medication, Wegovy is the one that is approved specifically for weight loss. Metformin doesn't have FDA approval as a standalone weight loss medication.

The results on Wegovy can be significant. Clinical studies showed participants lost around 15% of their starting weight during 68 weeks when combined with lifestyle changes.

However, people taking Metformin for diabetes may lose some weight, especially when the medication is combined with healthy eating habits and regular physical activity.

Metformin vs. Wegovy? Which one is better for cardiovascular health?

Metformin doesn't have FDA approval for preventing cardiovascular events. Metformin's primary role remains diabetes management rather than cardiovascular risk reduction.

In March 2024, the FDA approved Wegovy for reducing cardiovascular risk in adults with existing cardiovascular disease who are also overweight or obese.

The approval came after a major clinical trial involving more than 17,600 participants. Results showed that participants taking Wegovy were less likely to experience serious heart problems like heart attacks, strokes, or cardiovascular death when compared to those taking a placebo.

Metformin vs. Wegovy? Which one is better for treating liver disease

Metformin doesn't have FDA approval for treating MASH or other liver diseases. In August 2025, Wegovy became the first GLP-1 receptor agonist approved for treating MASH (metabolic dysfunction-associated steatohepatitis) with moderate to advanced liver fibrosis in adults without cirrhosis. This is a significant development for people with this serious liver condition.

The FDA based this approval on clinical trial results showing that nearly 63% of participants using Wegovy had their MASH resolve, while their liver scarring remained stable or improved. The medication also helped more than 37% of users experience improvement in liver scarring

Metformin vs. Wegovy: Which one has fewer side effects?

Both medications can cause side effects, though the types differ.

Metformin's most common side effects are gastrointestinal. Many people experience nausea, diarrhea, stomach discomfort, or gas, especially when starting the medication. Taking Metformin with food usually helps reduce these symptoms. Extended-release versions may cause fewer digestive issues.

Wegovy's side effects are also primarily gastrointestinal. Common issues include nausea, vomiting, diarrhea, constipation, and abdominal pain. These side effects are usually most noticeable when starting the medication or increasing the dose. They often improve as your body adjusts. The gradual dose increase helps minimize these effects.

More serious but rare side effects can include pancreatitis, gallbladder problems, and kidney issues.

Metformin vs. Wegovy: Which one is cheaper?

Metformin is usually much more affordable than newer medications. This generic drug has been available for decades and typically costs less than $20 per month without insurance. Most insurance plans cover it with low copays. As the first-line treatment for type 2 diabetes, metformin often requires no prior authorization from insurance companies.

Wegovy is significantly more expensive. However, the manufacturer Novo Nordisk recently announced price discounts starting November 17th, 2025:

• Existing self-pay or uninsured patients can get Wegovy for $349 per month ( a 30% reduction from $499 per month)
• New self-pay or uninsured patients can get the 0.25 mg and 0.5mg doses of Wegovy for $199 per month for the first two months
• If you have commercial insurance that covers Wegovy, savings programs may reduce your cost to as little as $0 per month
• This pricing is valid till 31st March 2026

Metformin vs. Wegovy: Which one does insurance cover?

Insurance coverage varies considerably between these medications.

Metformin enjoys widespread coverage. As a first-line diabetes treatment, nearly all insurance plans cover it with minimal restrictions.

Wegovy coverage for weight loss is more complicated. Many plans don't cover weight loss medications. However, Wegovy's approvals for cardiovascular health and liver disease may improve coverage chances in those situations.

Medicare

Traditionally, Medicare has not covered weight loss drugs. However, a new government agreement announced on November 6, 2025, changes this. For the first time, Medicare will cover Wegovy for weight management. Medicare beneficiaries are expected to pay just $50 per month. State Medicaid programs can also offer Wegovy at these reduced rates.

Most insurance plans cover Ozempic and Rybelsus for type 2 diabetes. Medicare typically covers these for diabetes management.

Medicaid

Medicaid coverage varies by state. Always check with your state’s Medicaid policy about diabetes and weight loss drug coverage and eligibility criteria.

Optimize weight loss and blood sugar control

Medications like metformin and Wegovy are only one piece of the puzzle. Your diet plays an equally strong role in your weight loss results and blood glucose levels.

Finding the right Wegovy diet can get complicated. A registered dietitian can help simplify this process.

How do dietitians help with weight loss and diabetes?

“A registered dietitian can help you follow personalized meal plans, keeping your meds in mind, address your specific health goals, and fit your lifestyle,” says Rita Faycurry, RD, Registered Dietitian.

They can:

• Create meal plans that work with your specific medication
• Balance carbohydrates with protein for better blood sugar control
• Adjust portion sizes for weight loss while keeping an eye on nutrients
• Modify your diet to help minimize the side effects of Wegovy, like nausea or digestive issues
• Tailor their recommendations to your lifestyle and food preferences

Final thoughts

Metformin and Wegovy serve different primary purposes. Metformin remains the first-line treatment for type 2 diabetes, with modest weight loss as a potential side effect.

Wegovy (semaglutide) is a weight loss drug that also provides cardiovascular and liver health benefits, but it is not approved to treat diabetes. Ozempic and Rybelsus are the semaglutide medications approved for type 2 diabetes.

All these medications need a doctor’s prescription and medical supervision. Talk to your doctor about your health needs and goals to determine the best treatment for you.

Frequently asked questions (FAQs)

Are metformin and Wegovy similar?

No, they're pretty different. Metformin is an oral medication that primarily treats type 2 diabetes by improving how your body uses insulin and reducing liver glucose production. Wegovy is an injectable GLP-1 medication primarily used for weight loss, heart disease risk reduction, and a specific type of liver disease.

Which is better, semaglutide or metformin?

Neither medication is universally "better." The choice depends entirely on what you're trying to treat.

For type 2 diabetes, metformin is typically the first medication doctors prescribe. If you need diabetes treatment with semaglutide, your doctor may prescribe Ozempic or Rybelsus.

For significant weight loss, cardiovascular risk reduction, or MASH (liver disease) treatment, semaglutide as Wegovy may be more appropriate.

Your healthcare provider can help determine which option fits your specific health needs and goals.

Is there a Wegovy pill?

There is no pill version of Wegovy for weight loss. However, Rybelsus is an oral form of semaglutide approved for type 2 diabetes.

For weight loss, another injectable option is Zepbound (tirzepatide). It works similarly to Wegovy but acts on two hormone receptors instead of one.

Both are prescription medications requiring a healthcare provider's evaluation. Your doctor will consider your health history, treatment goals, insurance coverage, and personal preferences when determining the appropriate medication.

Get the best diabetes diet plan custom-made by a dietitian who accepts your insurance.

The views expressed by authors and contributors of such content are not endorsed or approved by Fay and are intended for informational purposes only. The content is reviewed by Fay only to confirm educational value and audience interest. You are encouraged to discuss any questions that you may have about your health with a healthcare provider.