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 comparator does most of the work in how this gets reported, and it is not the comparator most people think they are citing.
What I am trying to establish is why A1C lags the way it does, and what to look at in the meantime if you want to know sooner. Numbers rather than impressions, if you have them.
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.
HealthEcon_DC 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…
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: 31 → 13 → 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.
HealthEcon_DC 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) | 125 | 99 | 89 | 83 |
| Insulin (fasting) | 21 | 13 | 9 | 6 |
| HOMA-IR | 5.5 | 4.1 | 1.7 | 1.4 |
| Uric Acid | 8.8 | 6.5 | 5.6 | 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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Shop Reference StandardsVendorMark said:Complete metabolic panel trending on glycaemic control — sharing because comprehensive data helps everyone: Test Baseline Month 3 Month 6 Month 12…
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.
Dr.PeteFamMed 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…
Can confirm. Same sequence, different timescale.