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Evidence-based GLP-1 & peptide discussion since 2023
ForumsMetabolic Health & DiabetesHas anyone dealt with prediabetes reversal on glp-1?

Has anyone dealt with prediabetes reversal on glp-1?

tony_orlando Sat, Feb 28, 2026 at 1:54 PM 9 replies 810 viewsPage 1 of 2
tony_orlando
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Orlando, FL
Feb 28, 2026 at 1:54 PM#1

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.

The narrow version of the question is why A1C lags the way it does, and what to look at in the meantime if you want to know sooner.

Happy to be told the question itself is wrong.

6 1NauseaFreeNow, SteveThurs, B12Beth and 3 others
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TrialNerd_Beth
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Bethesda, MD
Feb 28, 2026 at 2:11 PM#2
tony_orlando 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.

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: 26 → 14 → 7 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.

Last edited: Feb 28, 2026 at 6:11 PM
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LibrarianMeg
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Feb 28, 2026 at 2:28 PM#3
TrialNerd_Beth 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…

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

TestBaselineMonth 3Month 6Month 12
Glucose (fasting)1281069284
Insulin (fasting)241487
HOMA-IR4.53.92.01.2
Uric Acid8.66.85.94.9

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.

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sean_dublin
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Feb 28, 2026 at 2:45 PM#4
tony_orlando 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.

Second this. Nothing to add that would improve it.

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Dr.SurgeonPGH
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Feb 28, 2026 at 4:18 PM#5

Adding the clinical framing, because it changes how the question reads.

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

BiomarkerAssociationEvidence Level
Baseline BMIHigher BMI → greater absolute weight lossStrong
Fasting insulinHigher insulin → better responseModerate
GLP1R gene variantsrs6923761 → variable responsePreliminary
Baseline hsCRPHigher CRP → greater CV benefitModerate
Early weight loss (4 wk)≥3% at 4 wks → strong predictor of ≥10% at 68 wksStrong

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.

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