2019 Standard of Care

[xanet]

care.diabetesjournals.org/content/42/Supplement_1

[kite]

Dec 17, 2018 14:06:07 GMT -5 xanet said:

care.diabetesjournals.org/content/42/Supplement_1

Inhaled insulin is mentioned on S91, S97, S99

9. Pharmacologic Approaches to Glycemic Treatment: Standards of Medical Care in Diabetes—2019

care.diabetesjournals.org/content/42/Supplement_1/S90

[xanet]

Changed:

Rapid-acting inhaled insulin used before meals in patients with type 1 diabetes was shown to be noninferior when compared with aspart insulin for A1C lowering, with less hypoglycemia observed with inhaled insulin therapy (21). However, the mean reduction in A1C was greater with aspart (–0.21% vs. –0.40%, satisfying the noninferiority margin of 0.4%), and more patients in the insulin aspart group achieved A1C goals of ≤7.0% (53 mmol/mol) and ≤6.5% (48 mmol/mol). Because inhaled insulin cartridges are only available in 4-, 8-, and 12-unit doses, limited dosing increments to fine-tune prandial insulin doses in type 1 diabetes are a potential limitation.

To:

Rapid-acting inhaled insulin to be used before meals is now available and may reduce rates of hypoglycemia in patients with type 1 diabetes (20).

Changed:

Inhaled insulin is available for prandial use with a more limited dosing range.

To:

Inhaled insulin is available for prandial use with a limited dosing range; studies in people with type 1 diabetes suggest rapid pharmacokinetics (20). A pilot study found evidence that compared with injectable rapid-acting insulin, supplemental doses of inhaled insulin taken based on postprandial glucose levels may improve blood glucose management without additional hypoglycemia or weight gain, although results from a larger study are needed for confirmation (82).

[mannmade]

This is great news! Dr. K is having an effect! This should encourage more docs to start prescribing and should support the credibility of the testimonials! Thank you for posting!

[ilovekauai]

A big thank to all you posters here for doing this digging and enlightening me. Great news! Thank you.

[longliner]

The ship is turning!☺️

[akemp3000]

The moment this thread was posted, the pps went from being red all day to suddenly becoming green for the day. I know it's just a coincidence...maybe an omen

[peppy]

PHARMACOLOGIC THERAPY FOR TYPE 2 DIABETES

[awesomo]

Dec 17, 2018 15:08:01 GMT -5 akemp3000 said:

The moment this thread was posted, the pps went from being red all day to suddenly becoming green for the day. I know it's just a coincidence...maybe an omen

Yes, and this is with the broader markets getting hammered yet again.

[rockstarrick]

Dec 17, 2018 15:30:00 GMT -5 awesomo said:

Dec 17, 2018 15:08:01 GMT -5 akemp3000 said:

The moment this thread was posted, the pps went from being red all day to suddenly becoming green for the day. I know it's just a coincidence...maybe an omen

Yes, and this is with the broader markets getting hammered yet again.

Really great to get a mention like this in the new SOC guidelines.  I was thinking this may happen when I posted about it the other day.  If it was me, I would, in some way, talk about it !!
A PR, maybe a tweet !  Come on MNKD, it’s time to start hitting back !!
How do they expect this news to get around ?? 
I don’t get it.
😎

[longliner]

I love the holidays! The SOC improved language puts a song in my heart. In the spirit of the season, a little ditty for the shorts; (100,000 + shares) "I'll be there for you, these five words I swear to you, when you breath I wanna be the air for you, I'll be there for you" (at 41.95 per share). Enjoy the season all.

[mnkdfann]

Dec 17, 2018 15:23:44 GMT -5 peppy said:

PHARMACOLOGIC THERAPY FOR TYPE 2 DIABETES

Is there a mention of inhaled insulin in that flow-chart? (I don't see one, but I have bad eyes.) 

[goyocafe]

Nor Type 1.

PHARMACOLOGIC THERAPY FOR TYPE 1 DIABETES

Recommendations

9.1 Most people with type 1 diabetes should be treated with multiple daily injections of prandial and basal insulin, or continuous subcutaneous insulin infusion. A

The ADA notes Inhaled Insulin after all other alternatives,including surgery, and non-insulin options. In fact it is listed as the last alternate option to the recommended injectable therapy, less some combination injectable treatment. As far as I can tell, the ADA has done nothing to level the playing field between injectable prandial insulin and inhaled insulin. They are not our friend.

[mnkdfann]

Dec 17, 2018 14:27:35 GMT -5 xanet said:

Changed:

Rapid-acting inhaled insulin used before meals in patients with type 1 diabetes was shown to be noninferior when compared with aspart insulin for A1C lowering, with less hypoglycemia observed with inhaled insulin therapy (21). However, the mean reduction in A1C was greater with aspart (–0.21% vs. –0.40%, satisfying the noninferiority margin of 0.4%), and more patients in the insulin aspart group achieved A1C goals of ≤7.0% (53 mmol/mol) and ≤6.5% (48 mmol/mol). Because inhaled insulin cartridges are only available in 4-, 8-, and 12-unit doses, limited dosing increments to fine-tune prandial insulin doses in type 1 diabetes are a potential limitation.

To:

Rapid-acting inhaled insulin to be used before meals is now available and may reduce rates of hypoglycemia in patients with type 1 diabetes (20).

Changed:

Inhaled insulin is available for prandial use with a more limited dosing range.

To:

Inhaled insulin is available for prandial use with a limited dosing range; studies in people with type 1 diabetes suggest rapid pharmacokinetics (20). A pilot study found evidence that compared with injectable rapid-acting insulin, supplemental doses of inhaled insulin taken based on postprandial glucose levels may improve blood glucose management without additional hypoglycemia or weight gain, although results from a larger study are needed for confirmation (82).

Thanks for posting that, but I would personally encourage everyone to look at the full document for themselves. Download the complete pdf and search for inhaled insulin. 

The second change you noted above is correct, but incomplete. They also added in the next paragraph: "Inhaled insulin is contraindicated in patients with chronic lung disease, such as asthma and chronic obstructive pulmonary disease, and is not recommended in patients who smoke or who recently stopped smoking. All patients require spirometry (FEV1) testing to identify potential lung disease prior to and after starting inhaled insulin therapy." 

Sorry if this sounds negative, but I don't see the overall fantastic improvements others do. The language was cleaned up a bit, some new information was added. But we're talking a handful of lines in a 204 page document. Will many prescribers really notice? Or even spot the minor changes? And it's not like the remainder of the document (describing other options) remained static. I suspect several of them also scored some improved language. 

[ryster505]

I wonder how long it will take aged or traderdennis to chime in with some negative shit on this fabulous update. Merry Christmas.