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ForumsMetabolic Health & DiabetesIs it possible to reverse type 2 or am I dreaming — need advice Page 2

Is it possible to reverse type 2 or am I dreaming — need advice

pat_auckland Mon, Jan 20, 2025 at 6:12 PM 38 replies 2,488 viewsPage 2 of 8
Dr.GutHealth
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Jan 21, 2025 at 1:12 AM#6
pat_auckland 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…

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.

Last edited: Jan 21, 2025 at 6:12 AM
14 9VanRx_Mike, steve_okc, dave_SLC and 11 others
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DeniseRN_TPA
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Tampa, FL
Jan 21, 2025 at 3:57 AM#7

Following on from EndoResFellow — and this may be the naive question:

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

Last edited: Jan 21, 2025 at 6:57 AM
13 8hyun_seoul, jim_asheville, matt_MKE and 10 others
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Dr.PainCLE
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Jan 21, 2025 at 6:42 AM#8
Dr.GutHealth said:
Patient selection optimization for glycaemic control: emerging predictive biomarkers for GLP-1 agonist response include: Biomarker Association…

Glycemic variability as the key metric for glycaemic control success: my coefficient of variation (CV) on CGM dropped from 42% to 18%. 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.

12 7oliver_london, tane_welly, Dr.PathRoch and 9 others
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pat_auckland
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Auckland, NZ
Jan 21, 2025 at 9:27 AM#9
Dr.GutHealth said:
Patient selection optimization for glycaemic control: emerging predictive biomarkers for GLP-1 agonist response include: Biomarker Association…

PCOS success story with glycaemic control: as someone with polycystic ovary syndrome, this medication has been transformative beyond weight loss.

After 9 months: periods became regular for the first time in ever, testosterone levels normalized, acne cleared significantly, and — unexpectedly — my hormonal symptoms have almost completely resolved.

GLP-1 agonists address the insulin resistance at the root of PCOS. For PCOS patients, this isn't "just" a weight loss drug — it's treating our underlying metabolic dysfunction.

Last edited: Jan 21, 2025 at 1:27 PM
11 6MeganSA_TX, LarryQC_SD, wanda_boise and 8 others
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Dr.CardioMD
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Jan 21, 2025 at 10:36 PM#10
Dr.PainCLE said:
Glycemic variability as the key metric for glycaemic control success: my coefficient of variation (CV) on CGM dropped from 42% to 18%.

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 = 5.7 (insulin resistant) → Current = 1.1 (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.

33 6josh_phd_bmore, roxy_nash, tony_orlando and 30 others
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