This is the version of the explanation I wish somebody had given me, written down before I forget what confused me. It is about glycaemic control, and it is deliberately narrow — everything I am not confident about is marked as such.
What is actually established
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.
The condition it depends on
The caveat that HbA1c is unreliable in anaemia, haemoglobinopathies and recent blood loss, all of which are commoner than people assume. If it disagrees with fasting glucose or a CGM, that is worth chasing.
The practical version
Because it is glucose-dependent, this class carries a low intrinsic hypoglycaemia risk on its own — the risk arrives when it is combined with insulin or a sulfonylurea, which usually need reducing.
What I am not sure about
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. I have searched first, so if this is covered somewhere point me at it and I will read it.
— Dr.KarenChen · corrections welcome and will be edited into this post with credit