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Evidence-based GLP-1 & peptide discussion since 2023
ForumsMetabolic Health & DiabetesRemission of T2DM on GLP-1 — need advice

Remission of T2DM on GLP-1 — need advice

sean_dublin Sat, Oct 19, 2024 at 2:55 AM 27 replies 2,227 viewsPage 1 of 6
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sean_dublin
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Oct 19, 2024 at 2:55 AM#1

Putting this up for argument rather than for agreement. I have read it twice and I am still not certain what it supports.

HbA1c reflects roughly three months of average glycaemia weighted toward the most recent weeks, which is why repeating it at six weeks tells you very little. The improvement on this class comes from two directions — direct glucose-dependent insulin secretion and glucagon suppression, plus the indirect effect of weight loss on insulin sensitivity — and the second continues after the first has plateaued.

Where I think it is weakest: the completion rate deserves as much attention as the headline, because a large effect among those who finished is a different claim from a large effect among those enrolled.

So the question, as narrowly as I can put it: 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.

Note on sourcing:
Figures above are from the primary publication rather than the press summary. If a number here disagrees with one you have, post yours and we will work out which of us is reading a secondary source.
16 11hannah_MT, Dr.SportsMedIN, amy_econ_NJ and 13 others
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DataDave
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Oct 19, 2024 at 3:08 AM#2
sean_dublin said:
HbA1c reflects roughly three months of average glycaemia weighted toward the most recent weeks, which is why repeating it at six weeks tells you very…

My labs after 3 months on glycaemic control: A1C 5.7%, fasting glucose 87 mg/dL, fasting insulin 8 uIU/mL. My endo says these are "textbook perfect."

For context, my baseline A1C was 6.9% and fasting glucose was 132 mg/dL. The improvement has been dramatic and consistent.

15 10mike_nyc, VendorMark, COA_Karl and 12 others
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Dr.NateNeph
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Oct 19, 2024 at 3:21 AM#3
sean_dublin said:
HbA1c reflects roughly three months of average glycaemia weighted toward the most recent weeks, which is why repeating it at six weeks tells you very…

PCOS success story with glycaemic control: as someone with polycystic ovary syndrome, this medication has been transformative beyond weight loss.

After 11 months: periods became regular for the first time in a decade, testosterone levels normalized, acne cleared significantly, and — unexpectedly — my fertility specialist is optimistic about future conception.

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.

Last edited: Oct 19, 2024 at 5:21 AM
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PharmHunterJen
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Oct 19, 2024 at 3:34 AM#4
Dr.NateNeph said:
PCOS success story with glycaemic control: as someone with polycystic ovary syndrome, this medication has been transformative beyond weight loss.

Complete metabolic panel trending on glycaemic control — sharing because comprehensive data helps everyone:

TestBaselineMonth 3Month 6Month 12
Glucose (fasting)1311059183
Insulin (fasting)2713116
HOMA-IR5.53.21.91.5
Uric Acid7.97.15.85.2

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.

Last edited: Oct 19, 2024 at 9:34 AM
13 8Dr.PainCLE, mike_mealprep, NicoleRaleigh and 10 others
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RickReta_CO
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Oct 19, 2024 at 4:44 AM#5
DataDave said:
My labs after 3 months on glycaemic control: A1C 5.7%, fasting glucose 87 mg/dL, fasting insulin 8 uIU/mL.

Same experience, arrived at from the opposite direction.

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