Metformin alternatives in the UK: quick guide for people with type 2 diabetes

If metformin doesn’t suit you — because of side effects, kidney limits, pregnancy plans, or other reasons — you still have solid options in the UK. Below I list common drug classes, real brand names you’ll see in UK practice, and straight-up tips to help you talk with your GP or diabetes nurse.

Common drug alternatives available in the UK

Sulfonylureas — these increase insulin release. Names you’ll hear: gliclazide (Diamicron) and glimepiride (Amaryl). They work fast and are cheap, but can cause low blood sugar (hypoglycaemia) and weight gain.

DPP‑4 inhibitors — gentle on blood sugar and weight neutral. Examples: sitagliptin (Januvia) and linagliptin (Trajenta). They’re well tolerated and useful if hypoglycaemia is a concern, but they lower HbA1c less than some other drugs.

SGLT2 inhibitors — good if you want weight loss and heart or kidney benefits. Common UK names: empagliflozin (Jardiance), dapagliflozin (Forxiga), canagliflozin (Invokana). Watch for urinary infections and dehydration; discuss genital hygiene and sick-day rules.

GLP‑1 receptor agonists — strong on weight loss and blood sugar. Examples: liraglutide (Victoza), semaglutide (Ozempic injection, Rybelsus oral). They can cause nausea early on and are usually started under specialist care or with dietitian support.

Thiazolidinediones — pioglitazone (Actos) can lower blood sugar and help fatty liver, but may cause fluid retention and weight gain. Not ideal if you have heart failure.

Insulin — still a key option if oral drugs aren’t enough. It’s flexible and powerful but needs training for injections and hypoglycaemia management.

How to choose the right alternative

Pick based on your priorities: avoid low blood sugar? consider DPP‑4 or GLP‑1. Need weight loss and heart protection? ask about SGLT2 or GLP‑1. Have kidney limits? dose changes or certain drugs may be safer. Cost and NHS coverage matter too — some drugs are routinely available on the NHS, others may need specialist approval or be private prescriptions.

Practical questions to ask your GP: Which option fits my blood tests and kidney function? What side effects should I expect and how will we monitor them? Will this change my existing meds or require extra tests? Do I need a specialist or can my GP start this medicine?

Final practical tips: keep a record of blood sugar readings, read sick-day guidance for SGLT2s and insulin, and check drug interactions with other medicines you take. If weight is a major goal, mention it — that steers choices toward GLP‑1s or SGLT2s.

Want personalised advice? Bring a recent HbA1c and kidney function result to your appointment. Your GP or diabetes team can then suggest the safest, most effective alternative for you in the UK system.