|
Post by bigchungus91354 on Mar 18, 2019 10:09:27 GMT -5
Just saw a Trulicity commercial and one of the disclaimers was that Trulicity is NOT insulin. Could MNKD not include a statement that Afrezza is EXACTLY the same insulin your body should produce? Although, if it was truly bio-identical they would have no claim to a patent, so we know that would not be precisely accurate.
|
|
Dartman
Newbie
Posts: 21
Sentiment: Way Too Long
|
Post by Dartman on Mar 18, 2019 12:45:18 GMT -5
Just saw a Trulicity commercial and one of the disclaimers was that Trulicity is NOT insulin. Could MNKD not include a statement that Afrezza is EXACTLY the same insulin your body should produce? Although, if it was truly bio-identical they would have no claim to a patent, so we know that would not be precisely accurate. I'm pretty sure the insulin is the same. Its the FDKP binding and delivery method that's patented.
|
|
|
Post by sayhey24 on Mar 18, 2019 18:22:29 GMT -5
Aged - "they need to find out how to make people more willing to take insulin"
Step 1 - their doctor needs to prescribe Step 2 - their doctor needs to prescribe Step 3 - .... more of the same
Their doctors are going to follow the standard of care. When does the SOC say to prescribe RAAs? The answer is the very last step after basal. When should meal time insulin be prescribed? That would be the very first step if we were correctly medically treating the fact the first thing the T2 loses is the robust insulin release at meal time.
Why is this not done? Two reasons; compliance; and hypoglycemia.
Compliance - No one likes needles and the injections and asking a T2 to take 3 shots a day is not going to happen because they do not get the immediate feedback like a T1 and what they can put of today they will. If they could simply inhale, thats a game changer.
Hypoglycemia - RAAs are dangerous and the risk has given rise to the entire oral market. If they had a product like afrezza where its really really hard getting a severe hypo when not using other diabetes meds. Thats a game changer. What makes afrezza so different? Aside from the in/out speed it works with the liver which gets back in sync and prevents the lows.
The insulin manufacturers can now stop doing research on how to make people more willing to take insulin. If they really want to make this happen they can get behind Dr. Kendall's efforts and make afrezza Step 1 in T2 care. I doubt they will. In fact I think they will do everything they can to stop him. The problem is that a mythology has grown up around insulin. Look at the study; the biggest group, 35% of the people, think that taking insulin will increase their chance of complications. Most of the other objections have nothing to do with needles or hypos, it's around what insulin itself implies about their lifestyle. That is what the insulin manufacturers are trying to change and is (almost, since Afrezza does address needles and hypos to an extent) equally valid whether the insulin is RAA or Afrezza. Some of this is also a side effect of the choice we have in the medical system. If you are in a developing country I suspect that the range of treatment options is a lot more limited so you are going to be on insulin quicker. In the US if you want to avoid insulin there is a whole cocktail of drugs that will let you put off the move to insulin. Aged - I looked at the study. IMO they could have saved their money and just read Proboards. What does the study results say? Take out the feeling of failure and whats left - compliance ( injection phobia, etc) and hypoglycemia are the two big causes.
Now, the mythology as you call it is not mythology. It is reality. These people are doomed. They are only getting the insulin because everything else has failed just like the ADA's Step program's "Treat to Fail" protocol planned for. 35% believed that insulin causes blindness, renal failure, amputations, heart attacks, strokes, or early death AND FOR GOOD REASON. By the time they get what they should have gotten as the first step, its too damn late.
Insulin to these people is the reality they are going to get blindness, renal failure, amputations, heart attacks, strokes, or early death. This is the way it is. Blame the current insulins they suck. What doctor in their right mind is going to expect these people to take 3 shots a day, shoot up when they are out with friends or end up falling over from a hypo and maybe die? By the time they get the insulin its over and they know it. Its a last resort and its so damn dangerous the average PCP doesn't want to touch it and I don't blame them.
In 3 years that will no longer be the case as the afrezza story spreads. It sure would be nice if every BP got behind afrezza for the sake of these PWD lives but fat chance that is happening. Maybe at least the ADA will do the right thing and make afrezza the first step but afrezza may very well doom the ADA too as big corporate funding dries up.
|
|
|
Post by agedhippie on Mar 19, 2019 9:10:32 GMT -5
Aged - I looked at the study. IMO they could have saved their money and just read Proboards. What does the study results say? Take out the feeling of failure and whats left - compliance ( injection phobia, etc) and hypoglycemia are the two big causes.
Now, the mythology as you call it is not mythology. It is reality. These people are doomed. They are only getting the insulin because everything else has failed just like the ADA's Step program's "Treat to Fail" protocol planned for. 35% believed that insulin causes blindness, renal failure, amputations, heart attacks, strokes, or early death AND FOR GOOD REASON. By the time they get what they should have gotten as the first step, its too damn late. Insulin to these people is the reality they are going to get blindness, renal failure, amputations, heart attacks, strokes, or early death. This is the way it is. Blame the current insulins they suck. What doctor in their right mind is going to expect these people to take 3 shots a day, shoot up when they are out with friends or end up falling over from a hypo and maybe die? By the time they get the insulin its over and they know it. Its a last resort and its so damn dangerous the average PCP doesn't want to touch it and I don't blame them.
In 3 years that will no longer be the case as the afrezza story spreads. It sure would be nice if every BP got behind afrezza for the sake of these PWD lives but fat chance that is happening. Maybe at least the ADA will do the right thing and make afrezza the first step but afrezza may very well doom the ADA too as big corporate funding dries up. If we look again at the list for those that don't want to read the paper; Subjects failing to initiate prescribed insulin commonly reported- misconceptions regarding insulin risk (35% believed that insulin causes blindness, renal failure, amputations, heart attacks, strokes, or early death)
- plans to instead work harder on behavioral goals
- sense of personal failure
- low self-efficacy
- injection phobia
- hypoglycemia concerns
- negative impact on social life and job
- inadequate health literacy
- health care provider inadequately explaining risks/benefits
- limited insulin self-management training.
There are 10 significant blocks and while Afrezza address the two in red that leaves the other eight blocks to insulin adoption. Getting past the others is a matter of education which highlights the last three bullets - there needs to be a plan to address those if you want to resolve the others. I don't believe that simply relying on social media and word of mouth is going to do it. Doctors need to be sold on the idea that Afrezza is the way ahead and then they will educate the patients as they did with RAA. Right now the adverts are getting people used to the idea of hearing about Afrezza which will make them more comfortable over time with using Afrezza if they must use insulin. It doesn't address the reluctance to use insulin in the first place. That is going to require people to discard their ingrained beliefs about insulin. This will happen, but it's going to take a lot more than three years I suspect.
|
|
|
Post by sayhey24 on Mar 19, 2019 19:05:07 GMT -5
Aged - I looked at the study. IMO they could have saved their money and just read Proboards. What does the study results say? Take out the feeling of failure and whats left - compliance ( injection phobia, etc) and hypoglycemia are the two big causes.
Now, the mythology as you call it is not mythology. It is reality. These people are doomed. They are only getting the insulin because everything else has failed just like the ADA's Step program's "Treat to Fail" protocol planned for. 35% believed that insulin causes blindness, renal failure, amputations, heart attacks, strokes, or early death AND FOR GOOD REASON. By the time they get what they should have gotten as the first step, its too damn late. Insulin to these people is the reality they are going to get blindness, renal failure, amputations, heart attacks, strokes, or early death. This is the way it is. Blame the current insulins they suck. What doctor in their right mind is going to expect these people to take 3 shots a day, shoot up when they are out with friends or end up falling over from a hypo and maybe die? By the time they get the insulin its over and they know it. Its a last resort and its so damn dangerous the average PCP doesn't want to touch it and I don't blame them.
In 3 years that will no longer be the case as the afrezza story spreads. It sure would be nice if every BP got behind afrezza for the sake of these PWD lives but fat chance that is happening. Maybe at least the ADA will do the right thing and make afrezza the first step but afrezza may very well doom the ADA too as big corporate funding dries up. If we look again at the list for those that don't want to read the paper; Subjects failing to initiate prescribed insulin commonly reported- misconceptions regarding insulin risk (35% believed that insulin causes blindness, renal failure, amputations, heart attacks, strokes, or early death)
- plans to instead work harder on behavioral goals
- sense of personal failure
- low self-efficacy
- injection phobia
- hypoglycemia concerns
- negative impact on social life and job
- inadequate health literacy
- health care provider inadequately explaining risks/benefits
- limited insulin self-management training.
There are 10 significant blocks and while Afrezza address the two in red that leaves the other eight blocks to insulin adoption. Getting past the others is a matter of education which highlights the last three bullets - there needs to be a plan to address those if you want to resolve the others. I don't believe that simply relying on social media and word of mouth is going to do it. Doctors need to be sold on the idea that Afrezza is the way ahead and then they will educate the patients as they did with RAA. Right now the adverts are getting people used to the idea of hearing about Afrezza which will make them more comfortable over time with using Afrezza if they must use insulin. It doesn't address the reluctance to use insulin in the first place. That is going to require people to discard their ingrained beliefs about insulin. This will happen, but it's going to take a lot more than three years I suspect. Aged - this is why I said they should have saved their money on the study and just read Proboards.
Your list combines "Cause and Effect". The reason insulin is not taken until the very last ADA Step is because its not prescribed. Health care provider are not going to explain risks/benefits, they just don't prescribe.
The root cause why it is not prescribed is because of compliance (injection phobia, negative impact on social life and job, etc.) and hypoglycemia concerns. The effects of not prescribing are blindness, renal failure, amputations, heart attacks, strokes, or early death. These are not misconceptions these are realities. The study calling them misconceptions is clearly wrong.
The most dreaded words a doc can say to a T2 is insulin and the T2 will do what they can to avoid the grim reaper. Call it working harder on behavioral goals or simple denial, too bad so sad these PWDs are doomed and I will squarely place responsibility on the ADA and their Step program which afrezza has made obsolete.
Until the lawsuits start flying the ADA's way they will be slow to change the SOC and make afrezza Step 1 in fear of losing BP BIG money. Afrezza has been available over 4 years now so I am sure some enterprising lawyers are sharpening their pencils and finding some PWDS who are getting blindness, renal failure, amputations, heart attacks, strokes, or early death.
Heck, if during discovery the ADA says BP has pressured them not to change the Step program, I can see no reason the BPs should not be included in the suits. Now that sounds like big money for the lawyers. SNY has few excuses as they had access to all of Al's "Lost Studies" which Dr. Kendall is now publishing. They knew afrezza if given early would stop the progression in most T2s.
|
|