This gets cited here weekly, usually second-hand, so it is worth setting out what it does and does not establish.
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 population was selected and supported in ways a real cohort is not, so I would read the effect size as a ceiling rather than an expectation.
The question I want answered is why A1C lags the way it does, and what to look at in the meantime if you want to know sooner. I have searched first, so if this is covered somewhere point me at it and I will read it.
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.
SarahChen_PharmD 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…
Complete metabolic panel trending on glycaemic control — sharing because comprehensive data helps everyone:
| Test | Baseline | Month 3 | Month 6 | Month 12 |
|---|---|---|---|---|
| Glucose (fasting) | 129 | 107 | 93 | 85 |
| Insulin (fasting) | 25 | 15 | 9 | 5 |
| HOMA-IR | 5.5 | 4.0 | 2.1 | 1.3 |
| Uric Acid | 8.7 | 6.9 | 6.0 | 5.0 |
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.
SarahChen_PharmD 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…
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 = 6.0 (insulin resistant) → Current = 1.4 (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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Shop Reference StandardsJennaRN said:Insulin sensitivity test (HOMA-IR) on glycaemic control — arguably the most important metabolic marker most people aren't tracking: HOMA-IR = (fasting…
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: 29 → 13 → 6 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.
Dr.SportsMedIN said:Complete metabolic panel trending on glycaemic control — sharing because comprehensive data helps everyone: Test Baseline Month 3 Month 6 Month 12…
Same experience, arrived at from the opposite direction. Posting only so the count is not one.