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Is HbA1c a better monitoring choice than eGFR on orforglipron?

Asked 16 Jan 2025Modified 15 months agoViewed 22k times
20

Concretely: HbA1c · eGFR · orforglipron.

These are treated as interchangeable and I do not think they are.

If both are acceptable I would like to know that, so I can stop thinking about it.

What is the actual trade-off, and does it matter at the scale I am working at?

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M4
askedmz_4113101k35816 Jan 2025

4 Answers

Sorted by votes
23

Before reacting to any single value, check whether it is outside the interval by an amount larger than the assay's own variation.

Repeat before you react. A single abnormal value has a substantial probability of being within the combined biological and analytical variation of a normal one.

Headline results, principal programmes

TrialAgentnDurationPrimary result
STEP 1Semaglutide 2.4 mg1,96168 wk−14.9 % vs −2.4 % weight
STEP 2Semaglutide 2.4 mg, T2DM1,21068 wk−9.6 % vs −3.4 % weight
SURMOUNT-1Tirzepatide 5/10/15 mg2,53972 wk−15 / −19 / −21 % weight
SURMOUNT-4Tirzepatide, withdrawal67088 wkContinued loss vs substantial regain
SELECTSemaglutide 2.4 mg17,604~40 moMACE HR 0.80 (0.72–0.90)
FLOWSemaglutide 1.0 mg, CKD3,533~3.4 yrRenal composite reduced; stopped early
SURMOUNT-OSATirzepatide, OSA46952 wkAHI reduced with and without PAP

Haemolysis in the sample raises potassium and several enzymes spuriously. If a result is bizarre, ask whether the sample was flagged before building a theory on it.

Nothing here is medical advice. If something is out of range and you do not know why, that is a consultation rather than a research project.

Keep the full report, not the number. You will need the units and the interval later.

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DA
answeredDr_Rosalind_Achebe69k1471 Feb 2025
5Worth adding that the collection tube and how long the tourniquet was on move several of these analytes. – tobias_maartens 9 months ago
6Confirming that a repeat two weeks later resolved what looked alarming on a single draw. – sasha_ferreira 36 days ago
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14

Answer first: decide what you would do differently for each possible result before you order the panel. Anything that fails that test is a number you will worry about and not act on.

Same laboratory, same method, same time of day, same fasting state. Between-laboratory differences on several common analytes are larger than the changes people are trying to detect.

Keep the reports rather than the numbers. Units, reference intervals and methods all vary, and a bare number two years later is not comparable to anything.

Research-use compounds are not approved for human use, and no panel makes that safer.

Baseline first, then a repeat under identical conditions. Everything else is secondary.

edited 24 Feb 2025 by Dr_Colm_Fitzhenry — added the placebo-arm figures

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DF
answeredDr_Colm_Fitzhenry69k24712 Feb 2025
10

Answering this needs to distinguish screening from monitoring. A screening panel looks for the unexpected; a monitoring panel tracks something you already have a reason to watch.

Timing matters per analyte: cortisol and testosterone are diurnal, triglycerides are postprandial, and creatinine responds to hydration and to recent training. Fixing the conditions removes most of the noise.

It helps to be literal here: delta checks — comparing against your own previous value — are far more sensitive than comparing against a population interval, which is the argument for keeping a series rather than a snapshot.

Biological variation data are published per analyte and are the basis for the reference change value — the difference between two results that is larger than noise.

One out-of-range value on a twenty-analyte panel is expected. Two on a repeat is a finding.

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DF
answeredDr_Nadia_Farsi104k24710 May 2025
2Adding a vote because this deserves more of them. – Dr_Hanne_Solberg 6 months ago
3Any view on cystatin C where muscle mass is falling? Creatinine seems to mislead in exactly that case. – tare_and_weigh 8 months ago
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7

This is answerable, and the answer is mostly about which tests rather than how many.

A sensible core for this population is a full blood count, renal function with electrolytes, liver enzymes with bilirubin, a fasting lipid panel with apolipoprotein B, HbA1c and thyroid-stimulating hormone.

Ordering tests you will not act on generates anxiety and incidental findings, both of which have costs.

Same laboratory, same time, same fasting state, or the comparison is not a comparison.

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DL
answeredDr_Otto_Lindqvist72k5821 Jan 2025
5Small correction: eGFR is an estimate derived from creatinine, not a measurement, and the equation used matters. – eoin_mcgarry 10 months ago
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Your answer

Ask PeptideStack is a static archive. Posting is closed, but the norms are worth stating: answer the question that was asked, show your working, cite the trial or the certificate, and say plainly where the evidence runs out.

Not medical advice. Research-use-only compounds are not approved for human use.