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Post by goyocafe on Jun 21, 2018 12:02:13 GMT -5
Years ago I worked in sales with a colleague who was Hindu. Just before a big presentation he would always tell me how fortunate he was that he could prey to more than one god for good fortune. I’m pulling out my old Herman Hesse collection today with a similar mindset about the next few days. We’ve waited a long time to hear about STAT. Please don’t disappoint!
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Post by celo on Jun 21, 2018 12:19:55 GMT -5
I think like most, we were hoping to witness TIRs similar to what Afrezzauser can produce on a daily basis. Many other individuals that post on social media about their TIR also seem to get excellent results. The STAT study data as shown in the poster, however only shows a marginal increase in TIR. There are probably large differences in the way Afrezzauser goes about his daily diet/medications/exercise...and the individuals in the study. Only 17 finished the study that were using Afrezza. Hopefully, the full presentation of the study on Saturday will shine some light on those 17 individuals full data set.
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Post by harryx1 on Jun 21, 2018 12:25:19 GMT -5
Oddly it is my understanding that to be compliant using traditional RAA’s requires: 1. Taking 20 to 30 mins before you eat, which means no flexibility to change meal time 2. Injections 3. Counting carbs 4. Possible stacking with roller coaster 5. Higher risk of hypo which if occurs does contribute to artificially lower Hba1c 6. Much more complicated to use 7. Stigma for some, especially young adults...See article recently posted Now let’s look at Afrezza 1. No carb counting or very little 2. No needles 3. No stigma 4. Just a Bolus or two depending on post meal spikes which is still an issue with RAA’s 5. Freedom from pump if desired 6. Possible non diabetic Hba1c with no severe hypos as seen by multiple users Did I miss anything? Oh yeah, duh... compliance with any med would likely be better than non compliance... GLTAL’s!!! And there it is...sitting right in front of us. Maybe, just maybe, this is what is exciting to Mike and David. While there may not be a significant difference with TIR (not a problem but says we are just as good or even slightly better), Afrezza does exactly what all the other medications do with fewer complications, less hassle, better delivery of insulin, ultra-fast, and mimics the pancreas. We have the goods to prove that Afrezza does what all the other meds do, but we can show you how to live a better lifestyle and get better results with the same chit called insulin, head to head! We were looking in the wrong direction, turn around. I doubt they would have had this slide if TIR was insignificant or even slightly better... JMHO.
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Post by mannmade on Jun 21, 2018 12:35:50 GMT -5
Agree Harry. I thought of this slide when I did the recent post. It lends a bit of support although not proven, to the idea that AFREZZA will contribute to less future diabetic damage due to better (less) post prandial spikes imho.
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Post by hellodolly on Jun 21, 2018 12:51:43 GMT -5
Agree Harry. I thought of this slide when I did the recent post. It lends a bit of support although not proven, to the idea that AFREZZA will contribute to less future diabetic damage due to better (less) post prandial spikes imho. I still believe that you are onto something more significant, can we at least say qualitatively?
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Post by mango on Jun 21, 2018 14:56:29 GMT -5
HbA1c is a proxy Time-in-range assesses glucose homeostasis
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ADA
Jun 21, 2018 17:38:45 GMT -5
tomtabb likes this
Post by agedhippie on Jun 21, 2018 17:38:45 GMT -5
Oddly it is my understanding that to be compliant using traditional RAA’s requires: 1. Taking 20 to 30 mins before you eat, which means no flexibility to change meal time 2. Injections 3. Counting carbs 4. Possible stacking with roller coaster 5. Higher risk of hypo which if occurs does contribute to artificially lower Hba1c 6. Much more complicated to use 7. Stigma for some, especially young adults...See article recently posted Now let’s look at Afrezza 1. No carb counting or very little 2. No needles 3. No stigma 4. Just a Bolus or two depending on post meal spikes which is still an issue with RAA’s 5. Freedom from pump if desired 6. Possible non diabetic Hba1c with no severe hypos as seen by multiple users Did I miss anything? Oh yeah, duh... compliance with any med would likely be better than non compliance... GLTAL’s!!! Ok - let's get the facts: You have the dosing time the wrong way around. RAA has no requirement to pre-bolus. From the labels: Novolog - NovoLog should generally be given immediately (within 5-10 minutes) prior to the start of a meal.Humalog - HUMALOG should be given within 15 minutes before a meal or immediately after a meal. Apidra - Administer within 15 minutes before a meal or within 20minutes after starting a meal.This is why you are told to bolus just before you start to eat, or just after. Injections - meh. Carb counting - oddly carb counting is a recent invention. Carb counting allows tighter control, it's not mandatory and there are older ways of dosing which are not as effective. You have to carb count with Afrezaa as Mannkind proved in a trial - they gave the Type 1 group half the carbs they should have had and everyone went hypo. You always stack carbs, you even see people advocating it with Afrezza (second bolus after an hour). Stacking is not a problem. The lower hypo rate is because non-compliant TI users and users in the 171 trial run higher levels. That puts them further from the hypo zone. Run higher levels with RAA and you will get fewer hypos as well. Complicated? hardly! Stigma - definitely, but I doubt that will vanish if you are sucking on a whistle. Lastly there have been RAA users with non-diabetic numbers for years. That's not new. Tudiabetes even has a forum for them. I think Afrezza absolutely has a place and I would not want to see it gone. There are very definite reasons to take Afrezza, but that list just is not it. My list would be: - Always the same absorption - Predictable clearance - Fast onset
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Post by brotherm1 on Jun 21, 2018 17:49:57 GMT -5
Come on Hip, I know you can add more to your list. Give it your best shot. Whatdusay? Huh?
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ADA
Jun 21, 2018 18:22:23 GMT -5
mango likes this
Post by akemp3000 on Jun 21, 2018 18:22:23 GMT -5
RAAs - antiquated and barbaric - meh
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Post by sayhey24 on Jun 21, 2018 18:35:14 GMT -5
Mike C said, "doctors will be shocked at the results". Dr. Kendall says RAAs are antiquated and barbaric and that Afrezza should be the standard of care. Because of these type statements, it's my opinion that any attempts to dilute or downplay the STAT study results are not likely based on informed sound analysis. I look forward to hearing Dr. Kendall's most important interpretation and explanation. After all, it's likely the reason he left a global executive position at Lilly to join little Mannkind corporation. I was not aware Mike said that, when? I guess I missed it but I have to agree with him. Its significantly better than I was expecting and mirrors the 171 results in the non-compliant TI group which gives it huge credibility.
It seems some are missing the point this was a treat to target study and not a "change the target" study. A 33% reduction in severe hypos is huge. Lowing the target baseline for the RAAs would be rather dangerous and is reflected by the significantly higher number of hypos in the RAA <7.0 PWDs. Lowering their baseline might cause death.
However reducing the target from the 160 to 140 which appears very doable with afrezza with no significant hypo increase would not only greatly improve A1c it would also significantly improve the TIR number as most of the out of TIR was during sleeping.
I doubt current afrezza users like afrezzauser and others posting their results on social media are targeting 160 as their baseline.
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Post by compound26 on Jun 21, 2018 18:40:45 GMT -5
Mike C said, "doctors will be shocked at the results". Dr. Kendall says RAAs are antiquated and barbaric and that Afrezza should be the standard of care. Because of these type statements, it's my opinion that any attempts to dilute or downplay the STAT study results are not likely based on informed sound analysis. I look forward to hearing Dr. Kendall's most important interpretation and explanation. After all, it's likely the reason he left a global executive position at Lilly to join little Mannkind corporation. I was not aware Mike said that, when? I guess I missed it but I have to agree with him. Its significantly better than I was expecting and mirrors the 171 results in the non-compliant TI group which gives it huge credibility.
It seems some are missing the point this was a treat to target study and not a "change the target" study. A 33% reduction in severe hypos is huge. Lowing the target baseline for the RAAs would be rather dangerous and is reflected by the significantly higher number of hypos in the RAA <7.0 PWDs. Lowering their baseline might cause death.
However reducing the target from the 160 to 140 which appears very doable with afrezza with no significant hypo increase would not only greatly improve A1c it would also significantly improve the TIR number as most of the out of TIR was during sleeping.
I doubt current afrezza users like afrezzauser and others posting their results on social media are targeting 160 as their baseline.
A few weeks back, on the Afrezza users facebook group, there was a discussion on what level the users set their CGM for correction with Afrezza. I remember most users stated that they set it at 120, 130 or 140.
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ADA
Jun 21, 2018 20:27:20 GMT -5
Post by sayhey24 on Jun 21, 2018 20:27:20 GMT -5
Well, there you go 120, 130 or 140. What would the afrezza compliant and non-compliant A1c and TIR be if the target was 120, 130 or 140? It appears the STAT number was about 160 but what the study showed was targeting the 120, 130 or 140 makes a lot of sense.
I guess the easy follow-up study is to do exactly that. Take the same TI users and set a 140 target, then 130 and then 120 and let see what we get with hypos,TIR and estimated A1c.
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ADA
Jun 21, 2018 20:44:22 GMT -5
Post by agedhippie on Jun 21, 2018 20:44:22 GMT -5
Come on Hip, I know you can add more to your list. Give it your best shot. Whatdusay? Huh? Ok - lets give it a go I think the ones I gave are the big three: - Always the same absorption - Predictable clearance - Fast onset We could add (in order): - No need to split large shots to get linear results - No lipoatrophy - No bruises - No inadvertently stabbing your finger with the needle (that hurts!!!!) - Quick return to baseline (although that endo had a good point about the dangers of doing that if you are in the 400s) But the first three are the ones that really matter. -
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Post by pguererro on Jun 21, 2018 21:46:07 GMT -5
Isn’t gonna be “shock”
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ADA
Jun 21, 2018 22:04:23 GMT -5
via mobile
Post by sellhighdrinklow on Jun 21, 2018 22:04:23 GMT -5
Looks like he's having a Guinness at 7:30AMish 😁
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