Remission of T2DM on GLP-1 — what worked for you?

Dr.ObesityMed said:

Glycemic variability as the key metric for glycaemic control success: my coefficient of variation (CV) on CGM dropped from 40% to 20%.

My labs after 3 months on glycaemic control: A1C 5.5%, fasting glucose 75 mg/dL, fasting insulin 6 uIU/mL. My endo says these are "textbook perfect."

For context, my baseline A1C was 6.5% and fasting glucose was 130 mg/dL. The improvement has been dramatic and consistent.

jim_asheville 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.

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

The insulin resistance improvement (HOMA-IR) is what my endo focuses on most. Going from 4.5 to near 1.0 is a metabolic transformation.

BariatricNurseD said:

My labs after 3 months on glycaemic control: A1C 5.5%, fasting glucose 75 mg/dL, fasting insulin 6 uIU/mL.

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: 22 → 14 → 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.

One thing that is still open after nancy_portland’s answer:

What did you change at the same time, and can you separate the two now?

Dr.GastroMayo 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…

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

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.