The newest pill approved for type 2 diabetes in 2023 is Brenzavvy (bexagliflozin), which received FDA approval on January 20, 2023. It belongs to the SGLT2 inhibitor class, the same family as well-known medications like Jardiance and Farxiga, and works by helping your kidneys flush excess sugar out through urine. Beyond that single approval, 2023 also brought significant clinical trial results for higher-dose oral versions of semaglutide (the active ingredient in Ozempic) and an entirely new type of GLP-1 pill that could reshape diabetes treatment in the coming years.
How Brenzavvy Works
Brenzavvy lowers blood sugar by blocking a protein in your kidneys that normally reabsorbs glucose back into your bloodstream. With that protein blocked, more sugar passes into your urine instead of recirculating. The result is lower blood sugar levels without directly affecting insulin production.
The standard dose is one 20 mg tablet taken once daily in the morning, with or without food. You should swallow it whole rather than crushing or chewing it. If you miss a dose, take it when you remember, but don’t double up the next day. Brenzavvy is not recommended for people with significantly reduced kidney function (specifically an eGFR below 30), and it’s not approved for type 1 diabetes.
How It Compares to Existing SGLT2 Inhibitors
Brenzavvy performs on par with the SGLT2 inhibitors already on the market. In a head-to-head trial against Farxiga (dapagliflozin), both drugs lowered HbA1c by essentially the same amount: about 1.08% for Brenzavvy versus 1.10% for Farxiga over 24 weeks. Weight loss was also comparable, with participants losing roughly 2.5 kg (about 5.5 pounds) on Brenzavvy and 2.2 kg on Farxiga. Both drugs lowered systolic blood pressure by about 6 mmHg. Around a third of participants in each group reached an HbA1c below 7%, a common treatment target.
One area where Brenzavvy doesn’t yet match its competitors is in proven heart and kidney protection. Jardiance and Farxiga have large outcome trials showing they reduce the risk of heart failure hospitalization and slow kidney disease progression. Brenzavvy was studied in a cardiovascular outcomes trial, but it hasn’t yet built the same depth of evidence that those older drugs have accumulated over years of post-approval research.
What Brenzavvy Costs
Brenzavvy is priced at $50 per month regardless of whether you have insurance or Medicare. That’s notably cheaper than most brand-name SGLT2 inhibitors, which can run several hundred dollars a month without insurance. The manufacturer, Theracos, does not offer a separate co-pay card or patient assistance program because the flat $50 price is designed to serve that purpose. The drug is also available through Cost Plus Drug Company at the same price point.
Higher-Dose Oral Semaglutide
While not a brand-new drug, oral semaglutide (sold as Rybelsus) saw important trial results in 2023 that point toward stronger doses becoming available. The currently approved maximum dose is 14 mg. In the PIONEER PLUS trial, published in The Lancet, researchers tested 25 mg and 50 mg doses against the existing 14 mg dose in people whose diabetes wasn’t well controlled.
The results were significant. Over 52 weeks, HbA1c dropped by 1.5 percentage points with 14 mg, 1.8 points with 25 mg, and a full 2.0 points with 50 mg. Both higher doses also produced greater weight loss. These findings matter because oral semaglutide at 14 mg is generally considered less powerful than the injectable version. Higher doses could close that gap, giving people who prefer pills a more potent option.
The American Diabetes Association’s 2024 Standards of Care already recognizes semaglutide (along with tirzepatide) as having the highest weight loss efficacy among drugs approved for blood sugar management. If the higher oral doses gain approval, pills could deliver results that previously required injections.
Orforglipron: A New Kind of GLP-1 Pill
Perhaps the most anticipated development is orforglipron, made by Eli Lilly. Unlike oral semaglutide, which is a peptide that must be taken on an empty stomach with specific timing, orforglipron is a small molecule. That distinction matters practically: small-molecule drugs are generally easier to manufacture at scale, simpler to take, and potentially cheaper to produce.
Phase 3 trial results in people with obesity (without diabetes) showed meaningful weight loss over 72 weeks. The highest dose, 36 mg, produced an average 11.2% reduction in body weight compared to 2.1% with placebo. More than half the people on that dose lost at least 10% of their body weight, and about one in five lost 20% or more. The drug also improved waist circumference, blood pressure, triglycerides, and cholesterol. Side effects were mostly gastrointestinal (nausea, vomiting, diarrhea), consistent with other GLP-1 drugs, and were generally mild to moderate.
Orforglipron is not yet approved. It’s still in phase 3 trials for both obesity and type 2 diabetes. If it reaches the market, it could become the first small-molecule GLP-1 pill available, which would be a meaningful shift in how these drugs are delivered.
What Didn’t Make It
Not every experimental diabetes pill survived 2023 and 2024. Pfizer’s danuglipron, another oral GLP-1 that generated early excitement, has been discontinued. Despite meeting key goals in dose-optimization studies and identifying a once-daily formulation with competitive potential, Pfizer decided to stop development after reviewing all clinical data and receiving regulatory feedback. The company did not specify the exact reasons, but the decision narrows the pipeline of oral GLP-1 competitors.
Where This Leaves Treatment Options
For people with type 2 diabetes right now, Brenzavvy offers a new and affordable SGLT2 inhibitor option, though it works similarly to drugs that have been available for years. The more transformative changes are still approaching. Higher-dose oral semaglutide and orforglipron both represent a push toward pills that can match or approach the blood sugar and weight loss benefits of injectable GLP-1 drugs. The ADA’s current guidelines place GLP-1 drugs and tirzepatide at the top of the efficacy ladder for both glucose control and weight management, and the trend in development is clearly toward making that level of efficacy available in oral form.