A1C went from 7.4 to 5.6 over nine months and my prescriber was more interested in the fasting insulin, which I did not expect.
What I am trying to establish is why A1C lags the way it does, and what to look at in the meantime if you want to know sooner.
I would rather have one careful answer than five confident ones.
jim_asheville said:A1C went from 7.4 to 5.6 over nine months and my prescriber was more interested in the fasting insulin, which I did not expect.
Glycemic variability as the key metric for glycaemic control success: my coefficient of variation (CV) on CGM dropped from 40% to 20%. Target is <36%, with <30% being ideal.
Why this matters more than average glucose: large glucose swings cause oxidative stress, endothelial damage, and promote advanced glycation end-products (AGEs). A flat glucose line at 95 mg/dL is metabolically healthier than oscillating between 60 and 160, even if the average is the same.
Dr.ObesityMed said:Glycemic variability as the key metric for glycaemic control success: my coefficient of variation (CV) on CGM dropped from 40% to 20%.
Insulin sensitivity test (HOMA-IR) on glycaemic control — arguably the most important metabolic marker most people aren't tracking:
HOMA-IR = (fasting insulin × fasting glucose) ÷ 405
My numbers: Baseline HOMA-IR = 4.3 (insulin resistant) → Current = 1.5 (insulin sensitive)
Anything above 2.0 indicates insulin resistance. The goal is below 1.5. GLP-1 agonists address the root metabolic dysfunction, not just the symptoms. This is why they work so much better than calorie restriction alone.
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Browse GL Biochemjim_asheville said:A1C went from 7.4 to 5.6 over nine months and my prescriber was more interested in the fasting insulin, which I did not expect.
Can confirm. Same sequence, different timescale. I had assumed I was the exception until I read this.
From the other side of the consultation, briefly.
PCOS success story with glycaemic control: as someone with polycystic ovary syndrome, this medication has been transformative beyond weight loss.
After 9 months: periods became regular for the first time in ever, testosterone levels normalized, acne cleared significantly, and — unexpectedly — my hormonal symptoms have almost completely resolved.
GLP-1 agonists address the insulin resistance at the root of PCOS. For PCOS patients, this isn't "just" a weight loss drug — it's treating our underlying metabolic dysfunction.