Yes, I did say that (and I’m 68 now), so not much time. Yes, a lot of research seems to show benefits of GLP-1RA, I’ve read a lot of the literature. But here’s a principle I pay attention to: just because some agent is beneficial, doesn’t mean you have to take it. If you have already achieved a particular health goal, there is no need to keep adding drugs to address a resolved issue. For example, we are constantly reading that this or that drug or supplement “lowers inflammation” - but if your inflammation is already rock bottom, jumping on every new “anti-inflammatory” agent is not only unnecessary, but might be counterproductive. In the business I worked in, we called that approach “a hat on a hat” - you already are wearing a hat, putting on another hat is worse. There is a tendency for many biohackers to read about some drug/supplement showing “benefits” and immediately taking it without asking if they specifically need that supposed “benefit” - a hat on a hat on a hat on a hat. I try to avoid that. It takes a ton of research and a lot of evidence and thinking before any drug or supplement is included in my stack - the bar is high, not low.
Now, my blood sugar control has not been resolved so far. However, I am carefully implementing a plan to do so. In addition to empagliflozin 25mg/day I am taking, I will next trial acarbose to see if there is an effect, and then imeglimin. Both before any GLP-1RA. Why? Acarbose is a narrower MOA, and therefore more transparent to me (than GLP-1RA). It also has a longer track record including life extension in animal models (ITP) - no GLP-1RA has been tested for that. So I want to go with the sure small gray bird in the hand (acarbose) than the two very loud and colorful birds in the bush (GLP-1RA).
Here one thing is critical: in order to fix-correct-enhance your health situation, you must have as full an understanding of your condition as possible. Diabetes is characterized by some common symptoms and biomarkers, but you can get to that state (prediabetes is just a mild form of diabetes - it’s along a spectrum with an arbitrary cutoff point in A1c 5.7) in many different ways. There is one or more defect in your glucose handling chain. And the defect can be anywhere along the chain of glucose handling. That’s why one anti-diabetic medication works in one patient but not in another. Just taking a GLP-1RA doesn’t mean you will get the statistical average effect you see in studies - you are an individual. GLP-1RA might not be for you - or it might be a miracle drug for you. Nothing is guaranteed. If you look up Ralph DeFronzo he describes more than 8 different defects that can cause diabetes or insulin resistance. You need to address the one you have, and not simply gobble up any drug that says “anti-diabetic”. It might not be for you.
The user @cl-user has posted extensive genetic analysis of his prediabetes and the possible defect areas responsible. His situation is very similar to mine. He found that imeglimin addressed his glucose handling problem where many other drugs failed. I have looked at the MOA of imeglimin and I think it might be helpful in my case too. I also have additional reasons for going with imeglimin - its impact on mitochondrial health especially in pancreatic beta cells; the reason is that I also take rapamycin and rapamycin is definitely toxid to pancreatic beta cells - I want to ameliorate this rapamycin side effect if possible - and GLP-1RA is an unknown here.
So, I have reasons to try acarbose and imeglimin before reaching for a GLP-1RA. And if one or both of these drugs fix my problem, I would have to think long and hard if I need to put a hat on a hat and take a GLP-1RA. It is possible that a GLP-1RA would also fix my issues and in addition have more benefits than imglimin +/- acarbose - but I don’t know that. To establish that, I need to research GLP-1RA a lot more, which takes time. Meanwhile, I - at 68 - am not sitting still with my poor glucose handling - I have a plan I thought out pretty carefully and am implementing it. That doesn’t mean that one day I may not reach the conclusion that GLP-1RA are the bees knees and switch to that, but as I said, it takes me a long time to gain confidence that I know enough about the drug to gamble on it… like making sure that I know enough about poker/roulette or any gambling game before I put my chips down. Right now, I don’t feel I know enough to spin the wheel on GLP-1RA. YMMV.
