Post-prandial glucose control — need advice

Dr.ObesityMed 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…

Glycemic variability as the key metric for glycaemic control success: my coefficient of variation (CV) on CGM dropped from 36% 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.

One thing that is still open after CarlaRPh_TPA’s answer:

What would you measure differently if you were starting again?

Dr.NateNeph said:

Glycemic variability as the key metric for glycaemic control success: my coefficient of variation (CV) on CGM dropped from 36% to 22%.

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

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.

Dr.NateNeph said:

Glycemic variability as the key metric for glycaemic control success: my coefficient of variation (CV) on CGM dropped from 36% to 22%.

My labs after 3 months on glycaemic control: A1C 5.0%, fasting glucose 75 mg/dL, fasting insulin 4 uIU/mL. My endo says these are "textbook perfect."

For context, my baseline A1C was 6.5% and fasting glucose was 110 mg/dL. The improvement has been dramatic and consistent.

Dr.NutriCornell said:

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

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 = 5.6 (insulin resistant) → Current = 1.0 (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.