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c/t2dglp1·posted 1 year ago by u/chidi_abubakar

unpopular opinion: most of what gets said here about T2D is guesswork

Caution The Quiet One ×8 Sourced ×1

Posting this as a discussion rather than a claim: unpopular opinion: most of what gets said here about T2D is guesswork.

Sensor accuracy varies across wear, and readings on the first day are the least reliable. Calibration practice and compression artefacts explain many alarming single values.

Postprandial excursions typically respond earlier than fasting glucose, so the sequence people observe is not a sign that something is not working.

Incretin-based agents stimulate insulin secretion in a glucose-dependent manner, which is why hypoglycaemia risk with them alone is low. Risk rises with agents that act independently of glycaemia.

Ask me anything specific. Anything general I will probably get wrong.

1,565 up / 329 down83% upvoted40 commentsid wdr36j21 Jan 2025

40 comments

30 in this archive, depth 6

best — the order this archive was captured in

u/runa_grimaldi262 points·1 year ago

Certain conditions affect A1c independently of glycaemia. If a result looks inconsistent with the sensor data, that is a question for whoever manages your care rather than for this board.

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u/ilias_kaufmann0 points·1 year ago

A1c reflects average glycaemia over roughly the preceding three months, weighted towards the most recent weeks. It cannot show variability and it lags any change you make.

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u/gustav_lindholm1 point·1 year ago

A1c reflects average glycaemia over roughly the preceding three months, weighted towards the most recent weeks.

Agreed, and the glucose-dependence point is the reason the risk profile reads the way it does.

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u/chidi_abubakarOP1 point·1 year ago·edited

Panicked over a first-day sensor reading and rebuilt my week around it. It was the sensor.

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u/gustav_lindholm69 points·1 year ago

How long between the two A1c measurements?

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u/tomas_lokken24 points·1 year ago

How long between the two A1c measurements?

Adding the obvious one — bring the export, not the single number, to whoever manages this.

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u/sanne_laurent16 points·1 year ago

I would not compare your numbers to that population. Different baseline, different regimen, different trial.

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u/gustav_lindholm0 points·1 year ago

I would not compare your numbers to that population.

This is the distinction that resolves most of the confusion here — average versus shape.

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u/fabio_lehtinen1 point·1 year ago

This is the distinction that resolves most of the confusion here — average versus shape.

Disagreeing with this line: that endpoint is from the obesity programme and does not answer the question.

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[deleted]15 points·1 year ago

[deleted]

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u/kian_verhoeven154 points·1 year ago

The diabetes and obesity programmes are separate, with different populations and different primary endpoints. Reading a result across from one to the other is not a comparison.

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u/sten_palacios41 points·1 year ago

Push back: one sensor reading is not a data point worth acting on, especially in the first day of wear.

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u/a1c_arcMOD115 points·1 year ago

Left up. It distinguishes the sensor data from the lab result, which most posts here do not.

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u/kian_verhoeven33 points·1 year ago

Continuous monitoring shows the shape: postprandial excursions, overnight behaviour and time in range. Two people with identical A1c can have very different distributions.

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u/ferran_batista69 points·1 year ago

Careful, that is a regimen change suggestion and it needs to come from whoever manages your diabetes.

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u/meal_prep_mira54 points·1 year ago

a single high reading is not a trend

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u/milan_chukwu15 points·1 year ago

Right, and the diabetes programmes report glycaemic endpoints. Quoting an obesity trial result here is answering a different question.

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u/marta_trevino30 points·1 year ago

glycaemic control and weight are two different endpoints

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u/teodor_duarte12 points·1 year ago

That A1c change is inside the assay’s variability and the interval you measured over is too short.

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u/a1c_arcT2D55 points·1 year ago

a1c can be affected by things that have nothing to do with glucose

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u/hana_lehtinen21 points·1 year ago

time in range is the more informative number and it is newer

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u/rania_marchand14 points·1 year ago

Correction: that trial is the diabetes programme and the figure you quoted is its glycaemic endpoint, not a weight result.

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u/jonas_cardoso35 points·1 year ago

Variability dropped before the average did, which was visible on the sensor and invisible on the lab result.

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u/slow_logbook_notes3013 points·1 year ago

Disagree — that is an obesity trial endpoint and this thread is about glycaemic control.

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u/aleksi_eriksen-26 points·1 year ago

sensor accuracy varies and the first day of a sensor is the worst

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u/chidi_abubakarOP10 points·1 year ago

Disagree — that is an obesity trial endpoint and this thread is about glycaemic control.

slow_logbook_notes30 is right that the fasting number moves last. Knowing that in advance saves months of worry.

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u/piotr_bruun17 points·1 year ago

variability matters as much as the mean

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u/marisol_moreau25 points·1 year ago

dose for glycaemic control is not the same conversation as dose for weight

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u/lucia_balogun6 points·1 year ago

Kept fingersticks alongside the sensor for two weeks to sanity-check it. Worth doing once.

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u/kasper_cabrera13 points·1 year ago

Postprandial excursions flattened out first and the fasting number took months to follow. Nobody had told me to expect that order.

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Type 2 diabetes as the original indication: A1c trajectories, CGM traces, hypoglycaemia risk when stacked with sulfonylureas or insulin, metformin combinations, and why the weight-loss conversation sometimes drowns out the glycaemic one.

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