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Post by peppy on Jul 4, 2019 11:38:19 GMT -5
I see, the stuff is chit. Middle graph. Thanks aged. I hope we all have some fun today.
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Post by agedhippie on Jul 5, 2019 9:42:58 GMT -5
I see, the stuff is chit. Middle graph. Thanks aged. I hope we all have some fun today. The top graph would definitely benefit from more basal. The second graph as well, but to a lesser extent. They both achieve 100% TIR though.
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Post by peppy on Jul 5, 2019 11:15:38 GMT -5
I see, the stuff is chit. Middle graph. Thanks aged. I hope we all have some fun today. The group recommends a target range of 70-180 mg/dL [3.9-10.0 mmol/L] for individuals with type 1 diabetes and type 2 diabetes it does meet time in range recommendations for type 2. looks to be running 128 to 160. all the time. mostly between 150 to 160mg/dl. wt loss, T4 and T3 control control metabolism. Black box for thyroid cancer. I wonder if there is any relationship?
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Post by mango on Jul 5, 2019 13:58:25 GMT -5
I see, the stuff is chit. Middle graph. Thanks aged. I hope we all have some fun today. The group recommends a target range of 70-180 mg/dL [3.9-10.0 mmol/L] for individuals with type 1 diabetes and type 2 diabetes it does meet time in range recommendations for type 2. looks to be running 128 to 160. all the time. mostly between 150 to 160mg/dl. wt loss, T4 and T3 control control metabolism. Black box for thyroid cancer. I wonder if there is any relationship? Above 140 is microvascular damage. Help me understand why that is good here? The CGMs show nearing 170. Looks like chitty numbers to me, can't believe they recommend dangerous levels like that-180!
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Post by agedhippie on Jul 6, 2019 10:44:30 GMT -5
Above 140 is microvascular damage. Help me understand why that is good here? The CGMs show nearing 170. Looks like chitty numbers to me, can't believe they recommend dangerous levels like that-180! There is nothing magic about 140 other than that is the approximately the point at which you start to spill glucose into your urine. It is also a question of degree. What is the impact of a peak at 170? That needs to be quantified before it gets taken seriously. Meanwhile the medical world has decided that they can support 180 as the top limit, and even then only for 70% of the time. This is why Mannkind set the top limit of the range at 180 for their TIR numbers. It's what all the pharmas including Mannkind use and are measured against. People are at liberty to get tighter control if they feel the need. There is a long thread in tudiabetes devoted to discussing tight control and showing the CGM results - forum.tudiabetes.org/t/flatliners-club/
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Post by agedhippie on Aug 4, 2019 9:16:08 GMT -5
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Post by goyocafe on Aug 4, 2019 13:06:10 GMT -5
How many drugs does this new chart knock out of contention (and off the list of ADA recommended drugs) for purposes of meeting these thresholds? Just curious if the chart supports the meds they recommend or the best health benefits available to PWDs. Just an opining question.
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Post by agedhippie on Aug 4, 2019 16:20:04 GMT -5
How many drugs does this new chart knock out of contention (and off the list of ADA recommended drugs) for purposes of meeting these thresholds? Just curious if the chart supports the meds they recommend or the best health benefits available to PWDs. Just an opining question. I really don't know. There is very little data on TIR for drugs only regimes because there are limited options to act on the result. The numbers are chosen so if you hit them you should be pretty much on an A1c of 7.0, so for a type 2 you can flip that on it's head and say if you have an A1c of 7.0 or less your TIR is on target. I think somewhere in the paper I read that 10% TIR equals 1.0 of A1c so you could possibly extend that out further.
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Post by goyocafe on Aug 4, 2019 17:02:08 GMT -5
I really don't know. There is very little data on TIR for drugs only regimes because there are limited options to act on the result. The numbers are chosen so if you hit them you should be pretty much on an A1c of 7.0, so for a type 2 you can flip that on it's head and say if you have an A1c of 7.0 or less your TIR is on target. I think somewhere in the paper I read that 10% TIR equals 1.0 of A1c so you could possibly extend that out further.Read more: mnkd.proboards.com/thread/11294/new-recommendations-time-range-targets?page=2#Doesn’t trying to back into a TIR based on A1c completely negate the purpose of TIR to begin with? As we’ve had it explained before 30 minutes at 250 and 30 minutes at 50 equaling an 1 hour avg bg of 150 and an A1c of 7 (for example purposes) is not the same as 1 hour at 150. The first scenario yields a zero time in range which is exactly why A1c is not an optimal way to measure blood glucose management. I think tying A1c to TIR will diminish the importance and value of TIR. I also suspect that the tighter the range identified as “good” the more of the current list of approved drugs will be challenged to help keep PWDs in that range. Hence my question about how TIR ranges are being defined to begin with. Are they broad enough so as not to disrupt the status quo of recommended drugs that are sanctioned by the ADA, or to deliver the best outcomes for long and short term issues stemming from highly variable glucose fluctuations.
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Post by sayhey24 on Aug 5, 2019 5:22:02 GMT -5
What a bunch of bunk,"consensus targets". Why is this not in two parts; post prandial; FBG? The magical top natural post-prandial non-diabetic number seems to be 140 and if you are above it for 2 or more hours you will start to incur vascular degeneration. A typical non-diabetic 30 year old male will range 80 to 125 with a FBG of about 85.
How about a post prandial consensus target limit of 160 and you better take another hit of afrezza if after 1.5 hours you are still over 140 so a fasting target range should be 70-140 starting 2 hours after meals.
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Post by agedhippie on Aug 5, 2019 8:01:49 GMT -5
I really don't know. There is very little data on TIR for drugs only regimes because there are limited options to act on the result. The numbers are chosen so if you hit them you should be pretty much on an A1c of 7.0, so for a type 2 you can flip that on it's head and say if you have an A1c of 7.0 or less your TIR is on target. I think somewhere in the paper I read that 10% TIR equals 1.0 of A1c so you could possibly extend that out further.Read more: mnkd.proboards.com/thread/11294/new-recommendations-time-range-targets?page=2#Doesn’t trying to back into a TIR based on A1c completely negate the purpose of TIR to begin with? As we’ve had it explained before 30 minutes at 250 and 30 minutes at 50 equaling an 1 hour avg bg of 150 and an A1c of 7 (for example purposes) is not the same as 1 hour at 150. The first scenario yields a zero time in range which is exactly why A1c is not an optimal way to measure blood glucose management. I think tying A1c to TIR will diminish the importance and value of TIR. I also suspect that the tighter the range identified as “good” the more of the current list of approved drugs will be challenged to help keep PWDs in that range. Hence my question about how TIR ranges are being defined to begin with. Are they broad enough so as not to disrupt the status quo of recommended drugs that are sanctioned by the ADA, or to deliver the best outcomes for long and short term issues stemming from highly variable glucose fluctuations. Backing into the the TIR is less than perfect but lacking any real data it's the best that can be done. In Type 2 on non-insulin drugs (sulphas and, I think, TZDs aside) the tendency is to go high rather than low so the cancelling effect is reduced. It's definitely not optimal doing the reversal though. To date TIR has revolved almost entirely around insulin (hence the lack of non-insulin drugs data) so I think it is unlikely that they came up with the range based on the need to shelter non-insulin drugs. The low point, 70, is the boundary for hypoglycemia. I have no idea why they chose 180 as the top limit but historically that has been the upper limit on the two hour post prandial target.
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Post by agedhippie on Aug 5, 2019 8:10:44 GMT -5
What a bunch of bunk,"consensus targets". Why is this not in two parts; post prandial; FBG? The magical top natural post-prandial non-diabetic number seems to be 140 and if you are above it for 2 or more hours you will start to incur vascular degeneration. A typical non-diabetic 30 year old male will range 80 to 125 with a FBG of about 85. How about a post prandial consensus target limit of 160 and you better take another hit of afrezza if after 1.5 hours you are still over 140 so a fasting target range should be 70-140 starting 2 hours after meals. A consensus target is just that, a consensus. It doesn't mean that it is optimal or even correct. None the less these are now the parameters by which treatments will be judged until a new consensus emerges, and from past experience that could take a while. We may disagree, but ultimately they make the rules and if you want to compete those are the rules you will be judged by.
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Post by ktim on Aug 5, 2019 15:31:59 GMT -5
I really don't know. There is very little data on TIR for drugs only regimes because there are limited options to act on the result. The numbers are chosen so if you hit them you should be pretty much on an A1c of 7.0, so for a type 2 you can flip that on it's head and say if you have an A1c of 7.0 or less your TIR is on target. I think somewhere in the paper I read that 10% TIR equals 1.0 of A1c so you could possibly extend that out further.Read more: mnkd.proboards.com/thread/11294/new-recommendations-time-range-targets?page=2#Doesn’t trying to back into a TIR based on A1c completely negate the purpose of TIR to begin with? As we’ve had it explained before 30 minutes at 250 and 30 minutes at 50 equaling an 1 hour avg bg of 150 and an A1c of 7 (for example purposes) is not the same as 1 hour at 150. The first scenario yields a zero time in range which is exactly why A1c is not an optimal way to measure blood glucose management. I think tying A1c to TIR will diminish the importance and value of TIR. I also suspect that the tighter the range identified as “good” the more of the current list of approved drugs will be challenged to help keep PWDs in that range. Hence my question about how TIR ranges are being defined to begin with. Are they broad enough so as not to disrupt the status quo of recommended drugs that are sanctioned by the ADA, or to deliver the best outcomes for long and short term issues stemming from highly variable glucose fluctuations. I would also suspect that the range has been influenced by weighing issues of risk and compliance with regard to RAA vs still limited info on long term implications of TIR on health outcomes... i.e. they were looking at current mainstream treatments rather than trying to be aggressive and pick narrowest range possible with optimal use of new technologies like pumps and Afrezza. Might they tighten the range based on new technology demonstrating ability to do it safely, or would they only do so with larger/longer trials directly linking TIR to cardiovascular outcomes ? ?
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Post by sayhey24 on Aug 5, 2019 16:56:02 GMT -5
What a bunch of bunk,"consensus targets". Why is this not in two parts; post prandial; FBG? The magical top natural post-prandial non-diabetic number seems to be 140 and if you are above it for 2 or more hours you will start to incur vascular degeneration. A typical non-diabetic 30 year old male will range 80 to 125 with a FBG of about 85. How about a post prandial consensus target limit of 160 and you better take another hit of afrezza if after 1.5 hours you are still over 140 so a fasting target range should be 70-140 starting 2 hours after meals. A consensus target is just that, a consensus. It doesn't mean that it is optimal or even correct. None the less these are now the parameters by which treatments will be judged until a new consensus emerges, and from past experience that could take a while. We may disagree, but ultimately they make the rules and if you want to compete those are the rules you will be judged by. Aged - I think you are absolutely correct and we are in violent agreement. They make the rules. If MNKD continues to play by the rules afrezza script growth will be a slow slog. I am hoping today's announcement with One Drop is a step forward in changing the paradigm in how afrezza will be sold going forward. Direct to PWD clinics with 24/7 connected care is the fastest way to increase sales and by-pass the rules which are holding back afrezza sales. Hopefully they will announce a clinic partner soon and get 'er done.
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Post by stevil on Aug 5, 2019 19:03:43 GMT -5
Aged - I think you are absolutely correct and we are in violent agreement. They make the rules. If MNKD continues to play by the rules afrezza script growth will be a slow slog. I am hoping today's announcement with One Drop is a step forward in changing the paradigm in how afrezza will be sold going forward. Direct to PWD clinics with 24/7 connected care is the fastest way to increase sales and by-pass the rules which are holding back afrezza sales. Hopefully they will announce a clinic partner soon and get 'er done. If by playing by the rules you mean that Afrezza has to prove itself in the same way everyone else does, you are correct. Science is science. Hypotheses are just theory until you can prove them with reproducible data. Like it or not, these rules are rules for a reason. The board has hashed, rehashed, and then hashed again over a thousand times. It is the way it is and is the way it should be. Good medicine is not guesswork. As long as and until MC decides to make Afrezza more affordable, this will continue to be an issue. I'm not him, so I won't pretend to understand the rationale behind why he has set the price as high as he has. I'm sure he has good reason for it. But if you have to take twice as many doses as other prandial insulins, it will be cost-prohibitive for Afrezza to become the SOC. Cost is a real determining factor in the practice of medicine. The gold standard isn't always the standard of care if it is too expensive for all to have. There are other examples where cheaper tests/medications are given that are not as good of quality because it would help a broader amount of people to give the cheaper alternative vs the minuscule benefit of the best given to the few.
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