Number Needed to Treat's view of tight glycemic control

[xoxoxoxo]

Interesting wired.com article about "the number needed to treat" and the way lots of medicine is pretty useless.  That led me to looking up type 2 diabetes and found this article.


www.thennt.com/nnt/tight-glycemic-control-for-type-2-diabetes-over-5-years/

Bottom line is tight glycemic control isn't hugely valuable, but reducing hypoglycemia is huge.  This is just another reason why I think Afrezza has so much potential.

Original wired article: www.wired.com/2014/10/number-needed-to-treat/  

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Oct 19, 2014 13:04:44 GMT -5 xoxoxoxo said:

Interesting wired.com article about "the number needed to treat" and the way lots of medicine is pretty useless.  That led me to looking up type 2 diabetes and found this article.


www.thennt.com/nnt/tight-glycemic-control-for-type-2-diabetes-over-5-years/

Bottom line is tight glycemic control isn't hugely valuable, but reducing hypoglycemia is huge.  This is just another reason why I think Afrezza has so much potential.

Original wired article: www.wired.com/2014/10/number-needed-to-treat/  

The 'funny' part of this, and of the vast majority of adult studies that look at HbA1C for control (which is by a very long term average) but at the same time look at hypoglycemia which is by definition not an average. Why aren't we looking at highs also? Are they meaningless?

If anyone used average values in gestational diabetic studies they would be laughed at... We know that it pregnancy comtroling the average (a1c) is by far not enough to prevent damaging the foetus. Only tight control of post prandial glucose spikes can prevent foetal damage. There should be little reason why adults diabetics couldn't be monitored and treated the same way. I suspect that the studies woud be very very different and HbA1c would quickly stop being seen as meaningful or useful for tight glucose control.

Afrezza with a long acting insulin like Lantus (given 2 times a day but not daily) would excel at showing superior control of peak and valleys but not be that impressive if only looking at HbA1c. I also suspect outcomes for adults would be, on a longer time scale then the few months of gestational diabetics, much superior then competitors.

My bottom line: optimizing highs and lows matter while fine tuning HbA1C not so much. We are looking at the wrong biomarker (HbA1C) and as long as we keep making this error we will keep on having studies that show tight control does not matter. Then again there never was a drug that could alter easily and elegantly and beneficially BOTH highs and lows before. This is a paradigm shift and our medical understanding of diabetics will follow the science as it always does. Sanofi and obviously Mannkind sees all this. Those thinking we don't need inhaled insulin are missing the point badly. We need a better monomeric insulin and we need a better delivery system that doesn't use needles. Afrezza provides both. Win win win... And on top of that it doesn't need refrigeration (which will eventually show up in the label).


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