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%.
My labs after 3 months on glycaemic control: A1C 5.5%, fasting glucose 75 mg/dL, fasting insulin 6 uIU/mL. My endo says these are "textbook perfect."
For context, my baseline A1C was 6.5% and fasting glucose was 130 mg/dL. The improvement has been dramatic and consistent.
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.
Complete metabolic panel trending on glycaemic control — sharing because comprehensive data helps everyone:
| Test | Baseline | Month 3 | Month 6 | Month 12 |
|---|---|---|---|---|
| Glucose (fasting) | 114 | 108 | 90 | 86 |
| Insulin (fasting) | 20 | 16 | 10 | 6 |
| HOMA-IR | 4.5 | 3.5 | 1.8 | 1.3 |
| Uric Acid | 8.2 | 6.4 | 5.7 | 5.0 |
The insulin resistance improvement (HOMA-IR) is what my endo focuses on most. Going from 4.5 to near 1.0 is a metabolic transformation.
BariatricNurseD said:My labs after 3 months on glycaemic control: A1C 5.5%, fasting glucose 75 mg/dL, fasting insulin 6 uIU/mL.
Fasting insulin is the lab my functional medicine doctor cares about most for glycaemic control: it's a much earlier marker of metabolic dysfunction than glucose or A1C.
My fasting insulin: 22 → 14 → 5 uIU/mL over 9 months. Target is <7. By the time your fasting glucose is elevated, your insulin has been elevated for YEARS trying to compensate.
Ask your doctor to include fasting insulin in your bloodwork panel. It's cheap (~$20) and incredibly informative.
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Browse GL BiochemOne thing that is still open after nancy_portland’s answer:
What did you change at the same time, and can you separate the two now?
Dr.GastroMayo said:Fasting insulin is the lab my functional medicine doctor cares about most for glycaemic control: it's a much earlier marker of metabolic dysfunction…
Patient selection optimization for glycaemic control: emerging predictive biomarkers for GLP-1 agonist response include:
| Biomarker | Association | Evidence Level |
|---|---|---|
| Baseline BMI | Higher BMI → greater absolute weight loss | Strong |
| Fasting insulin | Higher insulin → better response | Moderate |
| GLP1R gene variants | rs6923761 → variable response | Preliminary |
| Baseline hsCRP | Higher CRP → greater CV benefit | Moderate |
| Early weight loss (4 wk) | ≥3% at 4 wks → strong predictor of ≥10% at 68 wks | Strong |
The 4-week early responder criterion is the most clinically actionable: if you haven't lost ≥3% by week 4 at a therapeutic dose, discuss optimization strategies with your provider.