New diabetes medications: what has been approved recently, and what is coming

Two of these are new molecules (the two weekly insulins), one is a new formulation of a known medicine, and one is a new use for an existing drug. That is typical: much of what counts as a new diabetes drug in a given year is a new form, dose or indication of a class already in use.

Yes, two, at different stages.

The Ozempic pill (approved)

On 4 February 2026 the FDA approved Ozempic as the name for semaglutide tablets in 1.5 mg, 4 mg and 9 mg strengths for adults with type 2 diabetes ^[1]. The active ingredient is the same semaglutide as in Rybelsus, available since 2019; Novo says the new tablets have higher bioavailability and give comparable therapeutic value to the original 3, 7 and 14 mg doses ^[1]. The label covers improving blood sugar alongside diet and exercise and reducing the risk of major cardiovascular events in adults at high risk ^[1]. Novo announced US availability from 4 May 2026 ^[7]. The semaglutide record covers the molecule.

Orforglipron (submitted for diabetes)

Orforglipron, sold for weight management as Foundayo since its approval on 1 April 2026 ^[8], is a non-peptide GLP-1 pill. Lilly submitted it to the FDA for type 2 diabetes in the second quarter of 2026 ^[5]; no decision on that application had been announced by the date of this page. In ACHIEVE-1, in 559 adults with early type 2 diabetes on diet and exercise alone, HbA1c fell by 1.24 to 1.48 points over 40 weeks against 0.41 on placebo ^[9]. In ACHIEVE-3, a head-to-head trial in 1,698 adults on metformin, orforglipron lowered HbA1c by 1.71 and 1.91 points against 1.23 and 1.47 for oral semaglutide 7 and 14 mg over 52 weeks ^[10].

The pill most people mean when they search for diabetes tablets is still one of the older oral classes; the glucose pills page covers those.

No new drug has replaced metformin, and no new class does what metformin does by the same mechanism. What has changed is the sequence. For years metformin was the usual first medicine, with others added later if blood sugar stayed high. Current guidance brings two other classes in earlier, sometimes first, for people with specific conditions, because those classes protect the heart and kidneys in addition to lowering glucose.

The ADA Standards of Care 2026 recommend, for adults with type 2 diabetes and chronic kidney disease, an SGLT2 inhibitor or a GLP-1 receptor agonist with demonstrated benefit, irrespective of HbA1c, to slow kidney disease and reduce cardiovascular events ^[11]. A new 2026 recommendation adds a dual GIP/GLP-1 receptor agonist for adults with type 2 diabetes, obesity and heart failure with preserved ejection fraction, again irrespective of HbA1c ^[11]. For established atherosclerotic cardiovascular disease, the Standards call for a medicine with proven cardiovascular benefit, such as a GLP-1 receptor agonist or SGLT2 inhibitor ^[11].

The ADA/EASD consensus report of October 2026 goes further. It advocates earlier use, potentially from diagnosis, of SGLT2 inhibitors and/or GLP-1-based therapies to protect organs and improve long-term outcomes, and earlier combination of the two in people who also have cardiovascular disease, chronic kidney disease or heart failure ^[6]. A primary-care summary of the report notes that it treats metformin as less of a required first step than UK NICE guidance does, because the heart and kidney benefits of these classes do not depend on metformin ^[12].

So the accurate answer to "what is replacing metformin" is: for people with heart disease, kidney disease, heart failure or obesity, SGLT2 inhibitors and GLP-1-based medicines are now recommended early and alongside, or sometimes ahead of, metformin; metformin itself remains in use. How a clinician weighs these depends on the person's conditions, other medicines, cost and tolerance. The comparison with insulin is covered in metformin vs insulin, and an SGLT2 example in Jardiance for type 2 diabetes.

People searching for a medicine similar to metformin usually mean one of three things, and each has a different answer.

• Another tablet that lowers blood sugar without causing low blood sugar on its own. SGLT2 inhibitors, DPP-4 inhibitors and oral semaglutide all fit that description, and the ADA Standards discuss each as a glucose-lowering option ^[11].
• Something with organ protection. That is where SGLT2 inhibitors and GLP-1-based medicines differ from metformin: the guidelines recommend them for kidney and cardiovascular benefit irrespective of HbA1c ^[11][6].
• Something that also helps with weight. The consensus lists weight management among the fundamentals of type 2 diabetes care ^[6], and a summary of it describes high-dose semaglutide and tirzepatide as the most effective weight-loss medicines it considers ^[12].

None of these is a drop-in substitute. Each class has its own side effects, cautions and costs, and the choice is made with a clinician who knows the rest of the person's health. The type 2 diabetes treatments page lays out the classes side by side.

The two new insulins of 2026 change how often basal insulin is injected, from daily to once a week. Awiqli (insulin icodec), approved on 26 March 2026 as a 700 units/mL injection, was compared with daily basal insulin in four ONWARDS trials in about 2,680 adults with type 2 diabetes and met its HbA1c endpoint ^[2]. Onswik (insulin efsitora alfa), announced as approved on 24 September 2026, was evaluated in more than 3,400 adults in the QWINT programme ^[3].

Both are approved for adults with type 2 diabetes only, alongside diet and exercise ^[2][3]. Onswik's prescribing information warns of low blood sugar (hypoglycemia), as insulin labels do ^[3]. A weekly insulin is a different product from a daily one, with its own dose-adjustment rules set out in its label, so a switch is a prescribing decision rather than a like-for-like swap.

Retatrutide had its first head-to-head diabetes result in October 2026: in TRANSCEND-T2D-2, 1,298 adults on metformin with or without an SGLT2 inhibitor were assigned to retatrutide 9 mg, 12 mg or Ozempic 2 mg for 80 weeks ^[13]. These are company topline figures, not yet peer reviewed. Lilly plans its first retatrutide filing, for obesity, in the first quarter of 2027 ^[5]. See the retatrutide record.

CagriSema was tested in type 2 diabetes in three REIMAGINE trials published in June 2026: on diet and exercise, on metformin, and on basal insulin ^[17][14][18]. Its weight-management filing is under FDA review ^[19]; the trials and dates are on CagriSema news and approval timeline, and the wider obesity pipeline on new weight-loss drugs. Tirzepatide, already approved, now carries the cardiovascular indication described above.