Prediabetic and scared - will this actually prevent diabetes? — looking for input

CarlaRPh_TPA 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 40% to 22%. 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.

JennaRN said:

Glycemic variability as the key metric for glycaemic control success: my coefficient of variation (CV) on CGM dropped from 40% to 22%.

My labs after 12 months on glycaemic control: A1C 6.0%, fasting glucose 90 mg/dL, fasting insulin 5 uIU/mL. My endo says these are "textbook perfect."

For context, my baseline A1C was 7.5% and fasting glucose was 135 mg/dL. The improvement has been dramatic and consistent.

CarlaRPh_TPA 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 experience, arrived at from the opposite direction.

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 = 4.5 (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.