Rybelsus vs Metformin: What's The Difference?

Dr. Constance Odom, MD

Medically reviewed by

Dr. Constance Odom, MD

Dr. Constance Odom, MD

About

Constance Tambakis Odom, MD graduated in 1987 with her Doctorate of Medicine from the New York Medical College, and was an Anesthesiologist Resident from 1988 to 1991 at the Brookdale Medical Center PGY II (CA-I)-PGY IV (CA-III). She is Board Certified by the American Board of Anesthesiology since 1998 and American Academy of Anti-Aging Medicine since 2002. Constance Odom, MD is affiliated with the American Medical Association, American Academy of Anti-Aging Medicine, American Society of Anesthesiology, Georgia Society of Anesthesiology, Hellenic Medical Society of New York, North Carolina Society of Anesthesiology, and Society of Ambulatory Anesthesia.

Credentials

Medical Director At:

• Nu Image Medical
• MetroMedispa P.A.

Staff Anesthesiologist at:

• Betsy Johnson Regional Hospital in Dunn, NC
• Onslow Memorial Hospital in Jacksonville, NC
• Duplin General Hospital in Kenansville, NC

Director of Anesthesia Services at:

• Jacksonville Surgery Center in Jacksonville, NC

Written by our editorial team.

Last Edited 1 year ago · 8 min read

When it comes to diabetes drugs, there are many similarities and differences between them. Some diabetes drugs are older than others. Two common diabetes drugs and Rybelsus and Metformin. While both are popular, these drugs have some key differences. Let’s get to know them now.

What is Rybelsus? Rybelsus is a medication designed to improve blood sugar or glucose levels in individuals with type 2 diabetes. The drug in itself is effective when it is combined with a healthy diet and exercise. Rybelsus can be combined with other medications. It imitates the way incretin hormones work in the body. Rybelsus comes from a drug class called Glucagon-like receptor agonists or GLP-1 medications.

Rybelsus

Rybelsus is different from similar medications like Metformin, because it is newer. Approved by the Food and Drug Administration (FDA) in 2019, Rybelsus is solely a brand-name medication. Unlike Metformin, Rybelsus does not come in generic form. Rybelsus comes in three different dosages: three milligrams, seven milligrams, and 14 milligrams.  

Although Rybelsus is not approved as a weight loss drug, many people find that they lose weight while taking this medication. Weight loss is a side effect of Rybelsus, and many people welcome it. Of course, you must combine Rybelsus with a healthy diet and exercise for it to be effective. This medication is approved to treat type 2 diabetes in adults. 

Rybelsus comes in tablet form and is taken once per day. You should take Rybelsus a minimum of 30 minutes before your first meal of the day. Rybelsus is made up of the active drug, Semaglutide. Rybelsus is a glucagon-like peptide-1 GLP-1) receptor agonist. 

Metformin is a first-line medication for the treatment of type 2 diabetes. It has been used for several decades now. Available as an oral tablet, a liquid, and an extended-release tablet, Metformin is a transformative medication. According to WebMD, Metformin is used in conjunction with a healthy diet  and exercise to control blood sugar in individuals with type 2 diabetes. 

This medication is beneficial, because it counteracts the devastating consequences of diabetes, such as blindness, problems with sexual function, and a potential loss of limbs. Controlling diabetes can decrease your chances of having a stroke or heart attack. But how does Metformin work?

Metformin helps your body react properly to the insulin it produces. It also reduces how much sugar that is manufactured by the liver. Additionally, Metformin limits how much sugar your intestines and stomach absorb. It is important to know how to take Metformin, so it is the most effective for you. According to experts, your pharmacist can provide you with a leaflet before you start taking this medication. 

You will receive this leaflet before you begin therapy with Metformin and each time you refill your prescription. While this leaflet contains helpful information, your doctor can provide you with additional information about the drug, should you need it. Metformin should be taken one to three times each day. It should be taken with meals, and doctors recommend that you drink enough water throughout the day. Fluids are necessary to stay hydrated. You should drink water throughout the day when you take this medication. This helps decrease your chances of experiencing side effects of Metformin. Drinking water also makes you feel full and less likely to snack on unhealthy foods. It's easy to grab a bag of chips or a slice of pizza when you want something quick. 

Drinking a lot fills you up and can prevent you from grabbing for convenient and unhealthy foods. An increased water intake can lead to weight loss. That is why it’s so important to load up on fluids when you take Metformin. 

How Metformin works

Metformin is an effective medication. However, it does not start working immediately after you take it. According to experts at Medical News Today, you typically see a reduction in blood sugar levels after 48 hours of taking the medication. You will see a more noticeable improvement after you have been on Metformin for four to five days. 

However, many medications have downsides, and Metformin is no exception. Experts say that in 2020, the FDA recommended that the makers of Metformin Extended Release pull this drug from the market, because it has cancer-causing agents or carcinogens that can cause problems later on.

While many people remain perfectly healthy while taking Metformin, some people may develop a Vitamin B12 deficiency that leads to feelings of tiredness, fatigue, and breathlessness. If you find that your Vitamin B12 levels dip too low on this medication, taking Vitamin B12 supplements may help. In rare cases, people develop lactic acidosis, a condition in which lactic acid builds up in the bloodstream. 

Lactic acidosis is a serious condition. It is probable that Metformin inhibits gluconeogenesis and blocks pyruvate carboxylase, a chemical needed to start gluconeogenesis. Gluconeogenesis is a process in which glucose is generated.     

The differences

While Metformin works by improving the way your body processes insulin and lower blood sugar levels, Rybelsus increases the amount of insulin your body releases. Another key difference between these medications is the fact that Metformin is used as a first line of treatment. Rybelsus, although effective, is not.  

Another key difference lies in the drugs’ side effects. While Rybelsus has been linked to thyroid tumors, Metformin is associated with lactic acidosis, as mentioned earlier. Copays for Rybelsus vary, while Metformin has low or no copays. 

With Rybelsus, there is a potential to develop eye problems that result from diabetes. In terms of cost, there are disparities between the two. According to K Health, a one-month supply of Rybelsus can cost anywhere from $700 to $1,200. This will depend on a number of factors, including your insurance coverage, location, and your pharmacy. If you have a prescription savings program, you may be able to save money on Rybelsus.

Many people may wonder which one of these medications is the better option for them. According to experts, it all depends on your situation. This depends on a number of factors, which include family history, your health, willingness to make lifestyle changes, and preexisting medical conditions. 

Ideally, your healthcare provider should be the judge. If the medication your doctor recommends is not covered by insurance, options are available. Your doctor may be able to set up a treatment plan that is more affordable. 

While Metformin is typically a first line of treatment, it is often prescribed along with Rybelsus for maximum benefit. In some cases, Rybelsus is prescribed for individuals who cannot take Metformin. According to Drugs.com, Metformin is known to cause changes in your sense of taste, while this isn’t a consideration with Rybelsus. 

However, there is a disparity in terms of ratings. Metformin has a rating of 6.9 out of 10, while Rybelsus has a rating of 5.7 out of 10. Nineteen percent of individuals on Metformin reported negative side effects, while 34 percent of those on Rybelsus reported negative side effects. The data show that both of these drugs have benefits and drawbacks.

However, the one you choose ultimately depends on your personal situation, risk factors, and family histories of certain illnesses. Metformin has the side effect of flatulence, while Rybelsus does not. Overall, Rybelsus is much more expensive than Metformin. Rybelsus can cost as much as $959 per month. Metformin, on the other hand, can cost as little as $16.02. 

Contrary to what many may think, Rybelsus and Metformin are not the same thing. These are both oral drugs used to “treat type 2 diabetes.” However, Rybelsus and Metformin come from different classes of drugs. Rybelsus is a GLP-1 receptor agonist. Metformin, on the other hand, comes from a class called biguanides. A biguanide is a colorless matter that dissolves when it is placed in water.

Rybelsus stands out against its peers, because it is the only oral dispense GLP-1 receptor agonist. All other GLP-1 medications come in the form of an injection. Of course, it’s important to remember that Rybelsus is equally as effective as other injectable versions of Semaglutide. 

There are several factors that differentiate Metformin from Rybelsus and make it suitable for other individuals. According to Ben’s Natural Health, Metformin has been treating diabetes much longer than Rybelsus has. Additionally, Metformin can treat the symptoms of PCOS. Metformin is safe to be taken during pregnancy and for those who are breastfeeding. Metformin is only a category B risk when it comes to pregnancy. 

Rybelsus, on the other hand, is not safe for individuals who are pregnant or breastfeeding. Metformin also has fewer rare and serious side effects than Rybelsus. While all drugs have pluses and minuses, it may be easier to take Rybelsus. Rybelsus only needs to be taken once per day. Metformin, on the other hand, must be taken two or three times each day. 

However, Rybelsus is an attractive option for those who fear needles. Rybelsus may not be the best option for those who need to eat something first thing in the morning.

Those who take Metformin typically lose roughly 13 pounds within the first six months of taking it.

12 Sources

Nu Image Medical has strict sourcing guidelines to ensure our content is accurate and current. We rely on peer-reviewed studies, academic research institutions, and medical associations. We strive to use primary sources and refrain from using tertiary references. 

https://www.goodrx.com/conditions/diabetes/rybelsus-vs-metformin

https://www.webmd.com/drugs/2/drug-11285-7061/metformin-oral/metformin-oral/details

https://www.drugs.com/medical-answers/rybelsus-work-3545198/

https://www.healthline.com/health/drugs/rybelsus#_noHeaderPrefixedContent

https://www.medicalnewstoday.com/articles/metformin-not-working

https://www.medicalnewstoday.com/articles/metformin-not-working#timing

https://medlineplus.gov/ency/article/000391.htm

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4264704/

https://en.wikipedia.org/wiki/Gluconeogenesis

https://www.khealth.com/learn/diabetes/rybelsus-vs-metformin/

https://www.drugs.com/compare/metformin-vs-rybelsus

https://en.wikipedia.org/wiki/Biguanide

This article is for informational purposes only and does not constitute medical advice. The information contained herein is not a substitute for and should never be relied upon for professional medical advice. Always talk to your physician about the risks and benefits of any treatment. Nu Image Medical may not offer the medications or services mentioned in this article.