This is eye-opening. So basically my PCP would think I'm "cured" based on A1C alone, while my endo sees that the underlying metabolic dysfunction is still very much present. That's actually a huge deal for treatment decisions — like whether/when to come off sema. Anyone know if HOMA-IR typically improves over time on GLP-1s with continued weight loss?

Yes, HOMA-IR does typically improve with sustained weight loss, but the timeline varies. Visceral fat loss is the biggest driver — that's the fat around your organs that drives insulin resistance. Some data: - 5-10% body weight loss: HOMA-IR typically drops 20-30% - 10-15% body weight loss: HOMA-IR drops 30-50% - >15% body weight loss: HOMA-IR often normalizes (approaches <2.0) - Exercise independently reduces IR, additive with weight loss But it's not linear. Some people hit normal HOMA-IR at 12% weight loss. Others need 20%+ before insulin sensitivity fully normalizes. Genetics play a role — some people are just more prone to IR at any weight. The important thing is trending it over time. Ask your endo to track HOMA-IR quarterly. Watching it improve is incredibly motivating and gives you a metabolic endpoint beyond just scale weight.