Dr.GutHealth said:

Worth knowing that the injection site changes very little.

I read this differently from Dr.GutHealth, on substance rather than tone. The trial means are being read too generously in this thread. STEP populations were selected, supported, and titrated by protocol, and the real-world curves are consistently a few points worse. That difference is not noise, it is what happens when you remove the study infrastructure.

Dr.GutHealth said:

Worth knowing that the injection site changes very little.

SUSTAIN-6 was the first CVOT to show cardiovascular benefit with semaglutide, relevant to cardiovascular risk. In 3,297 T2DM patients with high CV risk: MACE HR 0.74 (95% CI 0.58-0.95, p=0.02)[1].

Notable: the retinopathy signal in SUSTAIN-6 (HR 1.76) was subsequently attributed to rapid A1C reduction in patients with pre-existing retinopathy — not a direct drug effect. This has been confirmed in longer-term follow-up studies.

Dr.GutHealth said:

Worth knowing that the injection site changes very little.

Bookmarking. The distinction being drawn above is the one nobody else makes. I will report back once I have actually tried it.

From the other side of the consultation, briefly.

Lp(a) and cardiovascular risk: a nuance that matters. Unlike most lipid markers, Lp(a) is 90%+ genetically determined and doesn't really change with weight loss or GLP-1 therapy.

My Lp(a) has remained at 82 nmol/L across all time points. If yours is elevated (>50 nmol/L), you need additional risk mitigation strategies regardless of your GLP-1 response. Don't assume your medication is covering all cardiovascular risk factors.

Dr.PainCLE said:

Lp(a) and cardiovascular risk: a nuance that matters.

This is my experience too, for whatever a second data point is worth. Posting only so the count is not one.