Incretin effect in healthy vs T2DM — 12 month update

marco_milano 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.

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.

KevinCompounds said:

Glycemic variability as the key metric for glycaemic control success: my coefficient of variation (CV) on CGM dropped from 35% to 20%.

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 5.5 to near 1.0 is a metabolic transformation.

marco_milano 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.

Same pattern here, and in the same order. I had assumed I was the exception until I read this.

From the other side of the consultation, briefly.

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 = 6.1 (insulin resistant) → Current = 1.3 (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.