chris_chi24 said:Albumin binding above 99% is the whole reason weekly dosing works, and it is also why the trough matters more than the peak.
Thank you for spelling out the reasoning rather than just the conclusion. Adding it to my notes with a link back to this thread.
From the other side of the consultation, briefly.
The FLOW trial results on renal function and renal outcomes: semaglutide 1.0mg reduced the composite kidney outcome by 24% (HR 0.76, p=0.0003) in CKD patients with T2DM[1].
The trial was stopped early for efficacy — always a strong signal. GFR decline was 1.16 mL/min/1.73m²/year slower with semaglutide. This positions GLP-1 agonists alongside SGLT2 inhibitors as pillars of cardiorenal protection in T2DM.
ingrid_STO said:Steady state is the thing most people miss.
I will push back on the "any working dose is fine" framing. The maintenance evidence sits overwhelmingly at the top studied dose, and the extension data shows regain tracking dose reduction rather than tracking stopping. Holding low is reasonable; pretending it is evidentially equivalent is not.
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Shop Reference Standardssteve_okc said:FLOW is the relevant trial and it reported a meaningful reduction in kidney-disease progression and related death in people with type 2 diabetes and…
Kidney function labs on renal function — good news for anyone concerned about renal effects:
| Marker | Baseline | Month 6 | Ref Range |
|---|---|---|---|
| eGFR | 75 | 88 | >60 |
| Creatinine | 1.1 | 1.0 | 0.7-1.3 |
| BUN | 25 | 14 | 7-20 |
| UACR | 60 | 23 | <30 |
The FLOW trial demonstrated renal protective effects of semaglutide. My nephrologist is encouraged by the UACR improvement especially.
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