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ForumsMetabolic Health & DiabetesA1C target achievement rates — sema vs tirz comparison

A1C target achievement rates — sema vs tirz comparison

TrialTracker_MD Sun, Jun 7, 2026 at 9:22 PM 8 replies 266 viewsPage 1 of 2
TrialTracker_MD
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Jun 7, 2026 at 9:22 PM#1

Read the primary source rather than the write-up and the two do not agree, so here is what is actually in it.

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.

Where I think it is weakest: the population was selected and supported in ways a real cohort is not, so I would read the effect size as a ceiling rather than an expectation.

What I am after is why A1C lags the way it does, and what to look at in the meantime if you want to know sooner. Practical detail welcome, however dull — the duller the better.

Note on sourcing:
Figures above are from the primary publication rather than the press summary. If a number here disagrees with one you have, post yours and we will work out which of us is reading a secondary source.
15 10Dr.EM_Chicago, pete_RVA, CarlaRPh_TPA and 12 others
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BethLabQueen
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Jun 7, 2026 at 9:47 PM#2
TrialTracker_MD 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…

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 = 4.2 (insulin resistant) → Current = 1.4 (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.

14 9Dr.PulmRoch, maya_sedona, stefan_berlin and 11 others
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LabKate
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Jun 7, 2026 at 10:13 PM#3
TrialTracker_MD 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.

13 8Dr.SleepRoch, laura_annarbor, JenMemphis and 10 others
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Dr.LeslieOBGYN
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Jun 7, 2026 at 10:38 PM#4
LabKate said:
Patient selection optimization for glycaemic control: emerging predictive biomarkers for GLP-1 agonist response include: Biomarker Association…

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: 28 → 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.

Last edited: Jun 8, 2026 at 4:38 AM
12 7NicoleRaleigh, james_edin, FranDenver and 9 others
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hans_munich
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Jun 8, 2026 at 1:00 AM#5
BethLabQueen said:
Insulin sensitivity test (HOMA-IR) on glycaemic control — arguably the most important metabolic marker most people aren't tracking: HOMA-IR = (fasting…

Adding a me-too, because a thread of one person's experience is not much use. The detail I would add is minor and it is already implied above.

11 6emma_london, tammy_FL, Dr.LipidDallas and 8 others
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