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.
Because it is glucose-dependent, this class carries a low intrinsic hypoglycaemia risk on its own — the risk arrives when it is combined with insulin or a sulfonylurea, which usually need reducing.
The narrow version of the question is why A1C lags the way it does, and what to look at in the meantime if you want to know sooner.
Happy to be told the question itself is wrong.
marco_milano 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 35% 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.
KevinCompounds said:Glycemic variability as the key metric for glycaemic control success: my coefficient of variation (CV) on CGM dropped from 35% to 20%.
Complete metabolic panel trending on glycaemic control — sharing because comprehensive data helps everyone:
| Test | Baseline | Month 3 | Month 6 | Month 12 |
|---|---|---|---|---|
| Glucose (fasting) | 115 | 101 | 91 | 85 |
| Insulin (fasting) | 21 | 15 | 11 | 5 |
| HOMA-IR | 5.5 | 3.1 | 1.9 | 1.4 |
| Uric Acid | 7.8 | 6.5 | 5.8 | 5.1 |
The insulin resistance improvement (HOMA-IR) is what my endo focuses on most. Going from 5.5 to near 1.0 is a metabolic transformation.
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View Resultsmarco_milano 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.
Same pattern here, and in the same order. I had assumed I was the exception until I read this.
From the other side of the consultation, briefly.
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 = 6.1 (insulin resistant) → Current = 1.3 (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.