Trulicity vs Metformin Comparison

How does an older, “tried and true” diabetes medication like metformin match up against Trulicity, one of the newer diabetes medications on the market? 

We’ll compare trulicity vs metformin in this article, including their side effects, affordability, effectiveness, and side-by-side pros and cons.

What is metformin?

Metformin is one of the most frequently prescribed first-line medications for type 2 diabetes. The United States Food and Drug Administration approved metformin in 1994, making it one of the older diabetes medications still regularly used today.

Metformin is the generic name most commonly prescribed to patients, and the brand name for metformin is Glucophage. Patients take metformin orally as tablets with a dosage range of 500-2,550 milligrams daily.

Metformin is in a class of drugs called biguanides. Biguanides help reduce the amount of sugar your liver makes while also improving your sensitivity to the hormone insulin, helping to reduce high blood sugar. 

There are two types of metformin – regular and extended-release (XR). Extended-release metformin is only taken once daily instead of 2-3 times a day. Extended-release metformin is preferred if you have persistent side effects from taking regular metformin.

While metformin is most commonly used for type 2 diabetes, it’s also used “off-label” to help treat polycystic ovarian syndrome (PCOS), a hormonal disorder in women often stemming from insulin resistance. 

What is Trulicity?

Trulicity is the brand name for a GLP-1 receptor agonist called dulaglutide – there aren’t currently any generic options available for Trulicity.

The FDA approved Trulicity to treat type 2 diabetes in September 2014, and again in February 2020 to reduce cardiovascular events in people with and without heart disease.

GLP-1 receptors in your pancreas help increase insulin secretion while reducing glucagon secretion. Glucagon is a hormone that raises blood sugar levels. 

GLP-1 receptor agonists activate these receptors to help your body produce insulin to lower your blood sugar.

GLP-1 receptor agonists like Trulicity can also promote weight loss because they help reduce appetite and promote fullness by slowing stomach emptying. Slowed stomach emptying can also help promote more stable blood sugar levels. 

Trulicity comes in a prefilled injector pen with typical dosages ranging from 0.75-4.5 milligrams weekly.

Is metformin in the same class as Trulicity?

Metformin and Trulicity are not in the same drug classes. Metformin is a biguanide, and Trulicity is a GLP-1 receptor agonist.

GLP-1 receptor agonists are newer medications that have only been introduced in recent years but are gaining popularity largely due to their ability to promote significant weight loss.

Trulicity vs metformin effectiveness for diabetes

Trulicity

A 40-week clinical trial was conducted to assess the effectiveness of Trulicity for diabetes (along with Ozempic, another injectable GLP-1 receptor agonist). 

The study included 1201 patients with type 2 diabetes who were at least 18 years old. Participants’ blood sugar levels were previously uncontrolled on metformin alone, with their A1cs ranging from 7-10.5%.

The group receiving 0.75 milligrams weekly of Trulicity had their A1c levels reduced by an average of 1.1% compared to their baseline. 

The reduction in blood sugar levels was more drastic as the dosage of Trulicity was increased. The participants receiving 1.5 milligrams of Trulicity had an average reduction in A1c of 1.3% compared to 1.1% on 0.75 milligrams.

According to a 52-week clinical trial cited on the website for Trulicity, when the dose of Trulicity is increased to 3 milligrams weekly, the average reduction in A1c jumps to 1.6% and 1.8% with 4.5 milligrams weekly (the maximum dose). 

These results are based on a 36-week trial with a mean baseline A1c of 8.6% who were already taking metformin.

Metformin

According to studies, metformin is effective at lowering both fasting blood sugar and hemoglobin A1c levels. The reduction in blood sugar levels appears to be dose-dependent, so the more metformin you take, the more it will likely lower your blood sugar.

Metformin can lower blood sugar levels in both obese and non-obese patients with type 2 diabetes. One study found that hemoglobin A1c levels dropped by slightly over 1% in obese and non-obese patients after 12 months of taking metformin.

At maximum doses, metformin can lower your A1c by as much as 1.5%.

According to a meta-analysis of 35 studies, each lasting at least 12 weeks, metformin tends to lower A1c levels by around 1%, whether alone or in conjunction with other diabetes medications.

Bottom line: Trulicity appears to be more effective at lowering blood sugar and hemoglobin A1c levels compared to metformin.

What are the side effects of each medication?

Metformin side effects

• Heartburn
• Stomach pain
• Nausea or vomiting
• Bloating
• Gas
• Diarrhea
• Constipation
• Weight loss
• Headache
• Metallic taste in your mouth

Taking too much metformin can result in a rare but serious condition called lactic acidosis. It is quite rare and typically only seen in cases of intentional metformin overdose.

Trulicity side effects

• Nausea
• Diarrhea
• Vomiting
• Abdominal Pain
• Decreased appetite
• Indigestion
• Fatigue

More rarely, Trulicity and other GLP-1 receptor agonists might increase your risk of thyroid tumors/carcinoma, pancreatitis, gallbladder issues, and kidney problems.

What is the price difference between metformin and Trulicity?

Metformin is much more affordable than Trulicity. 

According to GoodRx, a bottle of 60 tablets (500 milligrams each) of metformin costs under $15 out of pocket at most pharmacies. 

Also, according to GoodRx, four prefilled pens (around one month’s worth) containing 3 milligrams each of Trulicity (mid-high end of 0.75-4.5 milligram dose range) cost around $770.

One of the reasons Trulicity is more expensive is that it’s a newer medication, and there aren’t any generic options available since the manufacturer still owns the patent.

You might be able to get discounts or apply for rebates if Trulicity is out of your budget or isn’t covered by your healthcare insurance or prescription drug coverage.

Ease of use for Trulicity vs metformin

Trulicity is a once-weekly injection, which might make it more convenient for people who have difficulty remembering to take their medications every day. However, it is an injection, which some people are wary of because of their fear of needles.

Metformin is an oral medication typically taken 1-3 times daily. Patients must take it every day, which isn’t convenient if you have a difficult time maintaining a medication regimen. The pills are on the larger side compared to some, but most people don’t have any issues swallowing them.

Trulicity vs metformin for weight loss

Trulicity

A study administered Trulicity to participants at 1.5, 3.0, and 4.5 milligram weekly doses for 52 weeks and assessed its impact on weight loss.

By week 36, the group receiving 1.5 milligrams of Trulicity lost an average of 3.1 kilograms (6.9 pounds), the group receiving 3 milligrams lost an average of 4 kilograms (8.8 pounds), and the group receiving 4 milligrams lost an average of 4.7 kilograms (10.3 pounds). 

The mean starting weight for all participants was around 211 pounds (96 kilograms), so the amount of weight loss with Trulicity ranged from around 3 to nearly 5% of the starting weights.

Metformin

A review of over 30 clinical trials summarized that taking metformin significantly reduced both weight and BMI. Researchers determined that doses of 1,000 milligrams or 3,000 milligrams daily (the maximum typical dose is 2,550 milligrams) were the most effective doses for promoting weight loss.

According to a study, people taking metformin for six months lost around 13 pounds (a little over 5% of their starting body weight). Patients who were more insulin-resistant lost more weight. 

Another study found that weight loss with metformin did not continue after the six-month mark.

Bottom line: Trulicity and metformin appear to have similar effects on weight loss, though individual results in terms of weight vary among people.

Metformin vs Trulicity for PCOS

Metformin

The medication metformin is commonly used to treat polycystic ovary syndrome (PCOS), a hormonal disorder impacting women of childbearing age. While metformin isn’t FDA-approved to treat PCOS, it’s often used “off-label” by many healthcare providers and fertility specialists.

PCOS is one of the leading causes of infertility in women. High levels of androgens (male sex hormones) can disrupt ovulation, the process when an egg is released to be fertilized. PCOS patients typically have long, irregular menstrual cycles since they don’t ovulate very often.

Metformin helps treat the most common root cause of PCOS, which is insulin resistance. Metformin helps sensitize cells to insulin which helps lower blood sugar levels, which can help improve hormonal imbalances and regulate irregular menstrual cycles.

Treatment with metformin might help increase ovulation rates in women with polycystic ovary syndrome, which could help achieve pregnancy in women who experienced infertility due to PCOS.

Metformin treatment has been shown to inhibit androgen production, which can help lessen some of the unwanted side effects of PCOS, like unwanted hair growth and hair loss.

Trulicity

GLP-1 receptor agonists aren’t commonly used to treat PCOS like metformin is. However, since they help improve insulin sensitivity and can promote weight loss, they might be used to treat PCOS in the future.

Some studies specifically mention the GLP-1 receptor agonists exenatide and liraglutide as good options for treating PCOS. 

Some healthcare providers might suggest GLP-1 receptor agonists for patients with PCOS who exhibit signs of insulin resistance and/or are considered overweight.

Benefits of Trulicity vs metformin

Benefits of Trulicity

Below are some benefits of taking Trulicity.

• Weekly dosing is convenient for some people
• Ideal for people with swallowing problems
• Might lower blood sugar more than metformin
• For some people, it might result in more weight loss than metformin alone
• Is FDA-approved to help reduce the risk of cardiovascular incidents
  • Likely by improving blood sugar levels which reduces heart disease risk and risk of cardiovascular events like heart attack and stroke

Benefits of metformin

Some benefits of taking metformin include:

• Less expensive than Trulicity
• Some prefer oral dosing
• Has a proven track record for treating PCOS
• Doesn’t have as many rare/serious potential side effects
• Has been used longer than Trulicity, so more is known about long-term safety

What’s better – Trulicity or metformin?

It’s impossible to subjectively say which medication is better. If you don’t have the money to spend on Trulicity and haven’t tried metformin before, it could be a good fit since it offers similar weight loss outcomes and a decent reduction in blood sugar levels.

If you’ve tried metformin and need an additional medication to help you reach your blood sugar goals, and it’s within your budget, then Trulicity might be a good alternative.

Alternatively, if you struggle with taking daily medications, Trulicity could be a good option to help you stick with your dosing schedule since it’s only once-weekly dosing.

Can you take Trulicity with metformin?

You can take metformin with many diabetes medications, including Trulicity. One of the benefits of both Trulicity and metformin is that they aren’t likely to cause hypoglycemia (low blood sugar).

Many healthcare providers prescribe Trulicity and metformin together, especially if you aren’t meeting your blood sugar goals with metformin alone.

Natural alternatives to metformin and Trulicity

If your healthcare provider has recommended metformin or Trulicity, it’s important that you don’t stop taking your prescription medications in favor of a natural alternative. While natural supplements and alternatives to medications can offer some benefits, they aren’t always effective enough to replace your prescription medication.

If you’re a candidate for natural alternatives, here are some to consider.

Resveratrol and probiotics

Resveratrol is a compound found in plant-based foods such as grapes, wine, peanuts, and soy. You can take resveratrol supplements to obtain the potential anti-inflammatory benefits.

Probiotics are beneficial bacteria that promote healthy digestion and support your immune system. Probiotics are found in fermented foods like yogurt, but are also widely available in supplement form.

According to an animal study, taking resveratrol and probiotics improved blood sugar levels, increased levels of GLP-1, and reduced levels of oxidative stress (which can lead to inflammation). Other studies have linked resveratrol to increased GLP-1 production in the intestines.

Berberine

Berberine is a compound in some plants like European barberry, goldenseal, goldthread, Oregon grape, Phellodendron, and tree turmeric. It is most well-known for its “anti-diabetic” properties by supporting healthy blood sugar levels and improving insulin sensitivity.

A pilot study compared metformin and berberine for their ability to help treat symptoms of type 2 diabetes. 

The researchers found that berberine produced identical results as metformin in terms of improving blood glucose metabolism. 

In addition, a small study on people with metabolic syndrome (a condition that can lead to type 2 diabetes) found that berberine improved insulin sensitivity and reduced participants’ waist circumference.

Conclusion

Trulicity and metformin are two different types of prescription diabetes medications – Trulicity is an injectable GLP-1 receptor agonist, and metformin is an oral biguanide.

Some of the benefits of metformin include its lower price, longer history of being used, fewer risks of rare complications, and its oral form.

Some of the benefits of Trulicity include its once-weekly dosing (convenient for those who don’t mind injections), its potential benefits in terms of heart health, and potential to reduce hemoglobin A1c levels more than metformin.

Trulicity and metformin can be used together to maximize potential blood sugar benefits.

If you doubt which medication might be best for you, your healthcare provider can help offer guidance.

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