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Evidence-based GLP-1 & peptide discussion since 2023
ForumsMetabolic Health & DiabetesA1C target achievement rates — looking for input

A1C target achievement rates — looking for input

SurmountFan_IN Fri, Jan 9, 2026 at 4:01 PM 30 replies 1,086 viewsPage 1 of 6
SurmountFan_IN
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Jan 9, 2026 at 4:01 PM#1

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 actually want to know 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.

8 3DebRD_ATL, KristenIndy, MarkLI_maint and 5 others
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TirzTom
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Jan 9, 2026 at 4:12 PM#2
SurmountFan_IN 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 18%. 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.

Last edited: Jan 9, 2026 at 8:12 PM
7 2tom_AK, josh_phd_bmore, roxy_nash and 4 others
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tane_welly
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Wellington, NZ
Jan 9, 2026 at 4:23 PM#3
TirzTom said:
Glycemic variability as the key metric for glycaemic control success: my coefficient of variation (CV) on CGM dropped from 35% to 18%.

Patient selection optimization for glycaemic control: emerging predictive biomarkers for GLP-1 agonist response include:

BiomarkerAssociationEvidence Level
Baseline BMIHigher BMI → greater absolute weight lossStrong
Fasting insulinHigher insulin → better responseModerate
GLP1R gene variantsrs6923761 → variable responsePreliminary
Baseline hsCRPHigher CRP → greater CV benefitModerate
Early weight loss (4 wk)≥3% at 4 wks → strong predictor of ≥10% at 68 wksStrong

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.

6 1DanielChem_CHI, marco_milano, pam_columbus and 3 others
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claudia_zurich
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Jan 9, 2026 at 4:34 PM#4
SurmountFan_IN 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.

This matches mine closely enough to be worth saying so out loud.

Last edited: Jan 9, 2026 at 10:34 PM
5 0alex_tucson, kevin_tulsa, Dr.PainCLE and 2 others
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paige_pharma
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Sep 2024
Omaha, NE
Jan 9, 2026 at 5:33 PM#5

Clinical perspective, offered as context rather than as advice.

My labs after 6 months on glycaemic control: A1C 6.3%, fasting glucose 88 mg/dL, fasting insulin 5 uIU/mL. My endo says these are "textbook perfect."

For context, my baseline A1C was 7.1% and fasting glucose was 123 mg/dL. The improvement has been dramatic and consistent.

Last edited: Jan 9, 2026 at 6:33 PM
4 24lucas_SP_BR, lisa_labSD, adam_van and 1 other
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