Which medicine comes first for type 2 diabetes?

Metformin. If diet and exercise are not keeping your blood glucose in range, metformin is usually the first medicine your doctor prescribes, and most people with type 2 diabetes start with it (healthdirect — Metformin, healthdirect — Diabetes medicines). It helps the insulin your body makes work well and reduces the glucose your liver releases. Unlike insulin it does not cause weight gain, it is unlikely to cause hypoglycaemia (low blood glucose), and it is taken with a meal or just after one.

Medicine does not replace the lifestyle side: healthdirect's advice is that diabetes medicines and lifestyle measures are both needed to stay well and lower the risk of complications. If metformin no longer works well enough on its own, your doctor may add a second medicine to it — and that is where the choice depends on your goal.

Which medicine for which goal?

After metformin, the second medicine is chosen for what matters most in your case. The table matches each goal with the classes the Australian sources describe for it, and says honestly which of them we can supply. Your doctor decides which medicine, and which dose, is right for you.

Your goalClasses that fitWhat the sources sayAvailable from us
Starting treatmentMetforminUsually the first medicine; most people start with it (healthdirect).Glucophage (metformin) — see the availability notes
Avoiding hyposMetformin, DPP-4 inhibitors (gliptins), SGLT2 inhibitors, glitazones, acarboseTaken on their own, these do not usually cause hypoglycaemia; sulfonylureas can (Diabetes Victoria).Glucophage; Januvia and Janumet are not currently available
Your weightGLP-1 receptor agonists, metformin, SGLT2 inhibitorsGLP-1 medicines can help you lose weight if you are overweight; metformin does not cause weight gain; sulfonylureas can cause weight gain (healthdirect, Diabetes Victoria).Rybelsus and Victoza — registered for type 2 diabetes, not for weight loss
Tablets, not injectionsMetformin, sulfonylureas, DPP-4 and SGLT2 inhibitors — and RybelsusGLP-1 medicines are injections, except Rybelsus: semaglutide as a daily tablet (healthdirect, ARTG).Rybelsus, Glucophage, Amaryl (glimepiride)
Protecting heart and kidneysGLP-1 receptor agonists, some SGLT2 inhibitorsGLP-1 medicines can lower the risk of heart and kidney problems; some SGLT2 inhibitors help protect the kidneys and lower the risk of heart disease (healthdirect).Victoza — its Australian indication includes reducing cardiovascular events in people at high risk

Sources: healthdirect — Diabetes medicines, Diabetes Victoria — Medicines for type 2 diabetes, healthdirect — Victoza, ARTG search.

Type 2 diabetes medicines, class by class

Each class lowers blood glucose a different way, and each has its own side effects. The examples are the medicines healthdirect names; the last column is what we can supply.

ClassExamplesHow it worksHypos on its own?WeightFrom us
BiguanidemetforminHelps your own insulin work and cuts the glucose your liver releasesUnlikelyNo gain; may help with weight lossGlucophage
Sulfonylureasgliclazide, glimepiride, glipizide, glibenclamideHelp your body release more insulinCan cause themCan cause gainAmaryl (glimepiride)
DPP-4 inhibitors (gliptins)sitagliptin, linagliptin, saxagliptin, alogliptin, vildagliptinIncrease your own insulin release and lower glucagonNo—Januvia, Janumet: not currently available
SGLT2 inhibitors (gliflozins)dapagliflozin, empagliflozinRemove more glucose in your urineNoMay help with weight loss—
GLP-1 receptor agonistsdulaglutide, liraglutide, semaglutideMore insulin after meals, less glucose from the liver, feeling full for longerNot usually with metformin; can with a sulfonylureaCan help you lose weight if overweightVictoza (injection), Rybelsus (tablet)
GlitazonepioglitazoneHelps your body use insulin more effectivelyNo——
Alpha-glucosidase inhibitoracarboseSlows the absorption of glucose from your gutNo——
Insulinseveral typesMoves glucose from the blood into your cells—Can cause gain (metformin does not)—

Side effects to know by class: metformin can upset the stomach and cause diarrhoea; SGLT2 inhibitors can cause urinary tract infections, genital thrush and dehydration; GLP-1 medicines can cause nausea, headache, dizziness, vomiting, diarrhoea or constipation; gliptins can cause a runny nose, sore throat and headache (healthdirect). Sources for the table: healthdirect's Diabetes medicines and Metformin pages and Diabetes Victoria.

Rybelsus, Ozempic and Wegovy: which is for what?

All three are semaglutide, but only Rybelsus and Ozempic are for type 2 diabetes. Ozempic is approved in Australia for type 2 diabetes and Wegovy for chronic weight management (healthdirect — Weight loss medicine); both are injections. Rybelsus is semaglutide as a daily tablet in 3, 7 and 14 mg, on the Australian Register of Therapeutic Goods since February 2022 for adults whose type 2 diabetes is not well enough controlled, alongside diet and exercise (healthdirect — Rybelsus). The same split applies to liraglutide: Victoza is approved for type 2 diabetes, Saxenda for weight management.

Weight loss is not the registered use of Rybelsus or Victoza. The Rybelsus label reports weight as a trial result in people with type 2 diabetes, and our Rybelsus page gives those numbers alongside the 30-minute rule for taking it. We sell Rybelsus and Victoza; we do not sell Ozempic, Wegovy or Saxenda. How semaglutide works is explained in semaglutide for type 2 diabetes.

Which diabetes medicines are on the PBS?

Metformin, glimepiride, Januvia and Ozempic are PBS-listed; Rybelsus is not. healthdirect records PBS availability for metformin and glimepiride brands and for Januvia, and the PBS lists semaglutide for type 2 diabetes only as Ozempic injection pens, as Authority Required items (PBS — semaglutide 14844G, 14163K). No Rybelsus tablet appears among them, and healthdirect's Rybelsus entry shows no PBS listing. A PBS listing comes with conditions your doctor checks. Medicines prescribed for weight loss are not covered by Medicare (healthdirect). What we charge is in the live price table on each product page.

Which diabetes medicines can you get from us?

Five medicines have live price tables: Rybelsus, Victoza, Glucophage, Amaryl and Prandin. Januvia and Janumet are not currently available. Every one of them is prescription-only in Australia. Before you order, know what each name is on the Australian register:

  • Rybelsus (semaglutide tablets) — on the ARTG (3, 7 and 14 mg, since 7 February 2022). Not on the PBS. Taken on an empty stomach, 30 minutes before food, drink or other tablets — including painkillers, as in can ibuprofen be taken with Rybelsus?
  • Victoza (liraglutide injection pen) — on the ARTG since 2010, registered for type 2 diabetes.
  • Glucophage (metformin) — the Glucophage brand name has no ARTG entry; metformin itself is registered under many other names.
  • Amaryl (glimepiride) — the Amaryl brand name has no ARTG entry; glimepiride is registered under other names.
  • Prandin (repaglinide) — a search of the ARTG for repaglinide returns no product, and it is not among the diabetes medicines healthdirect lists.
  • Januvia (sitagliptin) and Janumet (sitagliptin with metformin) — both on the ARTG and Januvia on the PBS, but not currently available from us.

The TGA says products not listed in the ARTG are not approved for supply in Australia and have not been reviewed for safety or quality (TGA, February 2024). Orders are sent from India or Hong Kong, not from an Australian warehouse: express parcels take 5–9 days and regular parcels 10–14 days, and orders from A$320 ship free (delivery conditions).

Sources