Rybelsus real-world vs clinical trial efficacy — need advice

Dr.ObesityLA said:

Orforglipron is the more interesting oral story because it is not a peptide at all.

I do not accept that the fasting window is a minor inconvenience. Adherence data on daily orals with timing requirements is consistently worse than weekly injections, and a drug you take imperfectly is a lower dose than the one on the box.

Adding the numbers, since they settle part of this. A quick sanity check on any figure quoted here: is it mean or median, is it intention-to-treat or completers, and what was the comparator. Three questions, and they resolve most disagreements in these threads.

COA_Karl said:

I do not accept that the fasting window is a minor inconvenience.

There is a second half to this that has not been said yet. Read four things before the headline number. The population, because trial populations are selected and supported in ways that real cohorts are not. The comparator, because "better than placebo" and "better than the current standard" are different claims and get reported identically. The primary endpoint as pre-registered, because a secondary endpoint promoted after the fact is a hypothesis rather than a finding. And the completion rate, because a large effect in the half of participants who finished is a different result from a large effect in everybody enrolled.

A narrower follow-up, since the general answer is now clear:

Whether the fasting requirement is as strict in practice as the label implies, and what people actually see when they get it wrong?

Reporting back.

Follow-up: moving the tablet to the moment I wake, before anything else, was the whole fix. The dose never changed.