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I have type 2 diabetes. Are GLP-1 medicines for me?

What Ozempic, Mounjaro and similar medicines do for blood sugar, where they fit in Canadian diabetes care, who pays, how they work with your other medicines, and what to read next.

GLP Guidebook teamUpdated 12 Oct 20267 min read23 sourcesWritten from published sources
The short answer

They may be. GLP-1 medicines such as semaglutide (Ozempic, Rybelsus and generic versions) and tirzepatide (Mounjaro) are approved in Canada for type 2 diabetes. They lower A1C (a blood test of your average sugar over 2 to 3 months, also called HbA1c), and often weight. Diabetes Canada says metformin usually comes first; these medicines are added to it, not used instead. Provincial plans cover semaglutide for type 2 diabetes with conditions. If you also take insulin or a sulfonylurea (an older type of diabetes tablet, such as gliclazide), your doctor may lower that dose to prevent low sugar.

Read this page first. It covers what's different when you have diabetes: where these medicines fit, who pays, your A1C, your other medicines, your kidneys and eyes. At the end, four guides take you further, in order.
On this page
  1. GLP-1s in diabetes care
  2. Who pays
  3. What A1C is
  4. What A1C to aim for
  5. GLP-1s and metformin
  6. Insulin, sulfonylureas and hypos
  7. Kidneys and eyes
  8. Weight loss with diabetes
  9. The risks, in brief
  10. What to read next
  11. Sources

Where do GLP-1s fit in Canadian diabetes care?

Usually as an add-on to metformin, not the first medicine. Diabetes Canada's guideline on diabetes medicines was last updated in 2020.1

Diabetes Canada says metformin should usually be chosen before other medicines, because it rarely causes low sugar or weight gain.1 A GLP-1 medicine comes in on top of it in situations like these:1

  • Heart or blood-vessel disease. For people with disease caused by narrowed arteries (such as a past heart attack or stroke), it recommends a GLP-1 medicine or an SGLT2 inhibitor (a tablet that makes the kidneys pass more sugar in urine) with proven heart benefit.1
  • When weight loss is a priority. GLP-1 medicines and SGLT2 inhibitors lead to weight loss, while sulfonylureas and insulin tend to add weight.1
  • When low sugar is a worry. GLP-1 medicines carry a lower risk of low sugar than sulfonylureas and insulin.1

Your family doctor, nurse practitioner or diabetes team prescribes them. In Canada, Ozempic is approved for type 2 diabetes, and also to lower heart and kidney risk in some people with diabetes. Mounjaro is approved for type 2 diabetes in adults and in children 10 and over.7,8

Canada note. In April 2026, Canada became the first G7 country to approve a generic semaglutide; generic versions of Ozempic have been on sale since May 2026.23 Ozempic and Rybelsus are approved for type 2 diabetes only, not for weight loss.7 Health Canada said the 2023–24 GLP-1 shortages had stabilized by January 2025.9 Guide 6 lists every Canadian brand.

Who pays for it?

For type 2 diabetes, provincial drug plans cover semaglutide, usually after metformin. Checked 12 Oct 2026.

  • Ontario. The Ontario Drug Benefit lists semaglutide and Rybelsus as Limited Use, for people whose sugar isn't controlled on the highest dose of metformin they can take, or who can't take metformin. It pays the generic price.5
  • British Columbia. PharmaCare covers it by Special Authority after metformin, up to 1 mg a week.6
  • Alberta. Covered under step therapy or special authorization; generic semaglutide was added from July 2026.22
  • Quebec. RAMQ lists Ozempic as an exception drug (médicament d'exception), with metformin when a sulfonylurea can't be used.22
  • First Nations and Inuit (NIHB). Ozempic and Rybelsus are Limited Use for type 2 diabetes.22
  • Tirzepatide (Mounjaro). We found no province that covers it; some private plans do.5,22

Other provinces and territories have their own rules; ask your pharmacist. See does your province cover Ozempic?

What is A1C, and how often is it tested?

A1C (also called HbA1c) is a common blood test that shows your average blood sugar over the last 2 to 3 months. It's the main number used to track type 2 diabetes.

Sugar in your blood sticks to hemoglobin, the protein in red blood cells. The test measures how much of it has sugar attached. The more sugar in your blood over those months, the higher the number.18 A finger-prick test shows your sugar at one moment. A1C is closer to an average over months.4

  • The Canadian unit. In Canada, A1C is given as a percentage, such as 7.0%.3
  • No fasting needed. It's a normal blood draw, at any time of day.17
  • How often. Diabetes Canada says at least every 3 months when you're not at target or your treatment is being changed.4
  • The diabetes range. An A1C of 6.5% or above is in the diabetes range.17
Good to know. Some conditions that change red blood cells, such as anemia or an unusual type of hemoglobin, or severe liver or kidney disease, can make A1C misleading.17 Your doctor can use other tests then.

What A1C should I aim for?

Diabetes Canada's usual target is 7.0% or lower. You and your doctor agree yours.

A lower target means less risk of long-term damage, but more risk of low sugar. That's why it differs from person to person.3,2

What two guidelines say:

Diabetes Canada

Usual target
7.0% or lower for most people3
When it may differ
6.5% or lower for some people with shorter diabetes, longer life expectancy and medicines with a low risk of low sugar; up to 8.5% for people who are frail or have limited life expectancy3

American Diabetes Association, 2026

Usual target
Below 7% for many adults2
When it may differ
Below 6.5% for some healthy people with a low risk of low sugar2

How do they compare with metformin, and can I take both?

Metformin is a common first tablet for type 2 diabetes. In a direct comparison, a weekly GLP-1 lowered A1C a little more than metformin. The two can also be taken together.

A fall in A1C of 1 point means, for example, going from 8% to 7%. The two trials below compared medicines with each other, not with a dummy treatment.

Average fall in A1C, in percentage points:

AWARD-3Dulaglutide (Trulicity) 1.5 mg weekly vs metformin tablets

807 people with type 2 diabetes, each on one medicine alone, 26 weeks (about 6 months).10

Dulaglutide 1.5 mg0.78
Metformin0.56
SURPASS-2Tirzepatide (Mounjaro) vs semaglutide (Ozempic) 1 mg, weekly

1,879 people already taking metformin, with an average A1C of 8.3% at the start, 40 weeks (about 9 months). People knew which medicine they were on. Paid for by Eli Lilly, the maker of tirzepatide.11

Tirzepatide 15 mg2.30
Tirzepatide 10 mg2.24
Tirzepatide 5 mg2.01
Semaglutide 1 mg1.86

These are averages from two separate trials with different people, so don't compare numbers across the two cards. The Ozempic label reports no new safety problems in 959 people who took it with metformin in trials.12

What if I also take insulin or a sulfonylurea?

Then your risk of low sugar (a hypo) goes up. Your doctor may lower your insulin or sulfonylurea dose when you start.

Sulfonylureas are older tablets such as gliclazide and glimepiride. They carry a higher risk of hypos than GLP-1 medicines.1 The Ozempic label warns that combining them can cause hypos, including severe ones.12 A lower sulfonylurea or insulin dose may reduce that risk.12 That's your doctor's call, so don't change doses yourself.

Signs of low sugar include:12

  • dizziness, shaking or sweating
  • hunger
  • blurred vision
  • a fast heartbeat
  • confusion or drowsiness
Get help now. Call 911 if someone with low sugar becomes confused, very drowsy or can't be woken. For health advice that isn't an emergency, call 811 in most provinces and territories (Info-Santé 811 in Quebec).19

What about my kidneys and eyes?

For kidneys, one large trial found fewer serious kidney problems on semaglutide in people who already had kidney disease. For eyes, tell whoever checks your eyes that you've started, especially if you have retinopathy (damage to the back of the eye from diabetes).

A large kidney trial followed 3,533 people who had type 2 diabetes and kidney disease, for about 3.4 years. Half took semaglutide (Ozempic) 1 mg a week, half a dummy injection with no medicine in it.13

The researchers counted everyone who had any one of these:13

  • kidney failure: needing dialysis or a transplant, or kidney function falling very low
  • losing at least half of their kidney function
  • dying from kidney or heart causes

Out of every 100 people, how many had one or more of these:

FLOWSemaglutide (Ozempic) 1 mg, weekly

3,533 people with type 2 diabetes and kidney disease, about 3.4 years.13

Semaglutide18.7 in 100331 of 1,767
Dummy injection23.2 in 100410 of 1,766

So about 4 or 5 fewer in 100 had one of these on semaglutide.

What this means. Semaglutide lowered the risk of these events by about a quarter (24%).13 Put simply: for every 22 people treated for about 3 years, one fewer person had kidney failure, a big loss of kidney function, or died from kidney or heart causes. The difference was clear enough that the trial was stopped early.13 This was in people who already had kidney disease, so it doesn't show the medicine protects healthy kidneys. Ozempic's Canadian label now includes lowering this risk in people with type 2 diabetes and kidney disease.7

But vomiting or diarrhea can dry you out, and that can damage the kidneys.12

Eyes. In a 2-year trial in people with type 2 diabetes, eye complications from retinopathy were more common on Ozempic than on a dummy injection. The gap was bigger in people who already had retinopathy.12

Out of every 100 people, how many had eye complications:

Ozempic US labelSemaglutide (Ozempic), weekly

A 2-year trial in people with type 2 diabetes.12

Everyone in the trial

Ozempic3.0 in 100
Dummy injection1.8 in 100

People who already had retinopathy

Ozempic8.2 in 100
Dummy injection5.2 in 100

Bars for eyes are drawn on a scale up to 10 in 100.

Report any change in your vision.12

Will I lose as much weight as people without diabetes?

On average, people with diabetes lost less in trials. Two trials of semaglutide 2.4 mg, the weekly dose sold as Wegovy, each ran for 68 weeks (about 16 months).

Average share of body weight lost, and what that means for someone who starts at 90 kg (198 lb):

STEP 2Semaglutide 2.4 mg (Wegovy), weekly

1,210 adults with type 2 diabetes and overweight or obesity, 68 weeks.14

Semaglutide9.6%about 9 kg
Dummy injection3.4%about 3 kg
STEP 1Semaglutide 2.4 mg (Wegovy), weekly

1,961 adults with overweight or obesity and no diabetes, 68 weeks.15

Semaglutide14.9%about 13 kg
Dummy injection2.4%about 2 kg

What this means. These are separate trials with different people, so the gap between them is a rough guide, not a direct comparison. They are averages too, so your own result may be higher or lower.

Questions to take to your doctor or diabetes team

  • What is my A1C target, and why?
  • Should my gliclazide or insulin dose change if I start?
  • Do I need an eye check first?
  • Will my provincial plan or insurance cover it, and is a generic available?
Side effectsGetting a prescriptionBefore you see a doctor

What to read next, in order

These four guides go deeper. Each one ends with a link to the next, so you can read them one after another.

  1. 1Weight and health: what BMI and waist numbers meanGuide 1 of 9UnderstandHow weight links to diabetes, and why the Canadian guideline uses a lower BMI line for Asian adults.
  2. 2What do GLP-1 medicines do?Guide 2 of 9UnderstandHow these medicines release insulin only when sugar is high.
  3. 3Side effects and risksGuide 5 of 9DecideStomach effects, and the risks that matter more with diabetes.
  4. 4Getting a prescription in CanadaGuide 6 of 9Do it safelyThe Canadian brands and generics for diabetes, who prescribes them, and what plans cover.
Was this page easy to understand?

Sources

  1. Lipscombe L et al.; Diabetes Canada Clinical Practice Guidelines Expert Committee. Pharmacologic glycemic management of type 2 diabetes in adults: 2020 update. Can J Diabetes 2020;44:575–91 (metformin usually first; GLP-1 RA or SGLT2i with cardiovascular benefit in ASCVD; weight effects; lower hypoglycemia risk than sulfonylureas and insulin). diabetes.ca
  2. American Diabetes Association. 6. Glycemic goals, hypoglycemia, and hyperglycemic crises: Standards of Care in Diabetes 2026. Diabetes Care, 2026;49(Suppl 1):S132. Recommendations 6.2, 6.3a, 6.4. Declared interests: 2 of 20 committee members declare consulting, advisory or grant ties to Novo Nordisk and 1 to Eli Lilly; 5 of 22 invited subject experts declare ties to each (ADA's own 2026 disclosure list). Full text
  3. Imran SA, Agarwal G, Bajaj HS, Ross S; Diabetes Canada Clinical Practice Guidelines Expert Committee. Targets for glycemic control (chapter 8). Can J Diabetes 2018;42(Suppl 1):S42–S46 (A1C ≤7.0% for most; ≤6.5% for some; ≤8.5% for some). guidelines.diabetes.ca
  4. Diabetes Canada Clinical Practice Guidelines Expert Committee. Monitoring glycemic control (chapter 9). Can J Diabetes 2018;42(Suppl 1):S47–S53 (A1C at least every 3 months when targets aren't met or treatment is adjusted). guidelines.diabetes.ca
  5. Ontario Ministry of Health. Ontario Drug Benefit Formulary (semaglutide and Rybelsus Limited Use; generic interchangeable; tirzepatide not listed). Checked 12 October 2026. formulary.health.gov.on.ca
  6. BC PharmaCare. Limited coverage drugs: semaglutide (Special Authority after metformin; up to 1 mg weekly), updated 21 April 2026. gov.bc.ca
  7. Novo Nordisk Canada. Ozempic (semaglutide injection) Product Monograph, 13 July 2026 (type 2 diabetes; reduction of cardiovascular and kidney risk in some adults with type 2 diabetes); Health Canada Drug Product Database (Ozempic and Rybelsus for type 2 diabetes). PDF
  8. Eli Lilly Canada. Mounjaro (tirzepatide injection) Product Monograph, 23 June 2026 (type 2 diabetes in adults and ages 10 to under 18). Health Canada Drug Product Database
  9. Health Canada. Drug shortages: supply notice for Ozempic ("As of January 27, 2025, the supply of Ozempic and other GLP-1 receptor agonists has stabilized"). canada.ca
  10. Umpierrez G et al. Efficacy and safety of dulaglutide monotherapy versus metformin in type 2 diabetes (AWARD-3). Diabetes Care, 2014;37(8):2168–2176. 807 people, 26 weeks. DOI
  11. Frías JP et al. Tirzepatide versus semaglutide once weekly in patients with type 2 diabetes (SURPASS-2). NEJM, 2021;385:503–515. All participants were on metformin (ClinicalTrials.gov NCT03987919). DOI
  12. Novo Nordisk. Ozempic (semaglutide) injection, US prescribing information and Medication Guide, revised May 2026. Sections 4, 5.3, 5.5, 5.6, 7.2, 8.5. (US label.) PDF
  13. Perkovic V et al. Effects of semaglutide on chronic kidney disease in patients with type 2 diabetes (FLOW). NEJM, 2024;391:109–121. 3,533 people, median 3.4 years. DOI
  14. Davies M et al. Semaglutide 2.4 mg once a week in adults with overweight or obesity, and type 2 diabetes (STEP 2). Lancet, 2021;397:971–984. DOI
  15. Wilding JPH et al. Once-weekly semaglutide in adults with overweight or obesity (STEP 1). NEJM, 2021;384:989–1002. 1,961 adults without diabetes, 68 weeks. DOI
  16. Novo Nordisk. Wegovy (semaglutide) US prescribing information, revised June 2026. Sections 1, 2.2, 5.2, 5.3, 5.5, 8.3, 17. (US label.) PDF
  17. Diabetes Canada Clinical Practice Guidelines Expert Committee. Definition, classification and diagnosis of diabetes, prediabetes and metabolic syndrome. Can J Diabetes 2018;42(Suppl 1):S10–S15 (A1C 6.5% or more in the diabetes range; conditions that make A1C misleading). Summary: pharmacists.ca
  18. Nathan DM et al. Translating the A1C assay into estimated average glucose values (ADAG). Diabetes Care, 2008;31(8):1473–1478. 507 people. DOI
  19. Heart and Stroke Foundation of Canada. Medical services by phone (811 in most provinces and territories). Checked 12 October 2026. heartandstroke.ca
  20. Health Canada. Adverse reaction and medical device problem reporting (Canada Vigilance Program; 1-866-234-2345). canada.ca
  21. Pedersen SD et al. Canadian Adult Obesity Clinical Practice Guideline: Pharmacotherapy for Obesity Management in Adults, 2025 update. Obesity Canada, Version 3, 11 August 2025 (pregnancy notes). obesitycanada.ca (PDF)
  22. Diabète Québec. Table of diabetes medications and their coverage (RAMQ, private insurance, NIHB), March 2026; Alberta Blue Cross Pharmacy Benefact 1330, July 2026 (generic semaglutide on the Alberta Drug Benefit List from 1 July 2026). diabete.qc.ca (PDF) · ab.bluecross.ca (PDF)
  23. Health Canada. Canada becomes the first G7 country to approve a generic version of semaglutide. 28 April 2026; Global News, generic semaglutide sales begin, 20 May 2026. canada.ca · globalnews.ca

Last checked 12 Oct 2026 · Next review due Jan 2027

How this page was made. Written by the GLP Guidebook team from the sources above: Canadian and US drug labels, published trials, Diabetes Canada and international guidelines, and provincial drug plans. It's general information, not medical advice. Talk to your family doctor, diabetes team or pharmacist before starting, stopping or changing any medicine. In an emergency, call 911. How we write