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

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

Often early, if you also have overweight or obesity. The American Diabetes Association (ADA) publishes the main US guidance, its Standards of Care, every year.¹

The ADA's 2026 Standards say that when choosing diabetes medicines for people with overweight or obesity, doctors should favor ones that help with weight. Its preferred choice for weight in people with diabetes is semaglutide or tirzepatide.¹

• Heart or blood-vessel disease. Ozempic is FDA-approved to lower the risk of heart attack, stroke and heart-related death in people with type 2 diabetes and heart disease, and Mounjaro to lower that risk in people with type 2 diabetes at high risk.^12,7
• Kidney disease. Ozempic is also approved to lower the risk of kidney function getting worse, kidney failure and heart-related death in people with type 2 diabetes and chronic kidney disease.¹²

Your own doctor or diabetes team prescribes them. Who pays:

• Private or employer insurance. GLP-1s for type 2 diabetes are covered more often than for weight, usually subject to your plan's drug list and prior authorization.³ If your plan covers it, the makers' savings cards may lower your copay.
• Medicare. Medicare drug plans (Part D) can cover GLP-1s for type 2 diabetes. The temporary $50 GLP-1 Bridge is not for people with type 2 diabetes; they go through their own drug plan.^4,5

What is HbA1c, and how often is it tested?

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. HbA1c is closer to an average over months.²

• The unit. US results are given as a percentage. Some countries use mmol/mol instead: 6.5% is the same as 48 mmol/mol, and 7.0% is the same as 53 mmol/mol.²
• No fasting needed. It's a normal blood draw, at any time of day.¹⁷
• How often. The ADA says at least twice a year, and more often, such as every 3 months, if you're not meeting your goal or your treatment has just changed.²
• The diabetes range. An HbA1c of 6.5% (48 mmol/mol) or above is in the diabetes range.¹⁷

What HbA1c should I aim for?

The ADA's usual goal is below 7% for many adults. 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.²

What the ADA says:

The ADA is the American Diabetes Association. Its Standards of Care are updated every year.

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 HbA1c a little more than metformin. The two can also be taken together.

A fall in HbA1c 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 HbA1c, in percentage points:

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 pills that make the pancreas release insulin, and they can cause hypos on their own.¹² 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

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:

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. The FDA has approved Ozempic for this use.¹²

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:

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 200 lb (91 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.

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 some US guidance uses lower BMI numbers for Asian Americans.
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 the USGuide 6 of 9Do it safelyThe US brands approved for diabetes, who prescribes them, and how insurance and Medicare pay.