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Post by sayhey24 on Nov 22, 2023 16:08:18 GMT -5
From Bill… “In answer to Mango, we used the various discount programs that were available. Ultimately it led us to Eagle and the $99-$199 monthly cost. We were in regular conversation with MannKind Cares and they helped but still patients eventually found the cheapest route was the specialty pharma like Eagle. And that was still too high for many patients, especially when the alternatives were essentially free.” Great info. So the $99 a month is still too high for many patients. I wonder if MannKind could renegotiate to say, $50 a month or even $25 a month through Eagle if that would help. I’m assuming many of these patients are low income/poverty and that $99 a month is a lot for them. We have to do better! Medicare is $35 but again for 2024 pre auths are required. About 50% of T2s are on Medicare. Thats the market MNKD needs to target. They also get a nearly free CGM if they are using afrezza and don't let anyone tell you DXCM and Abbott are not aware of this. The problem is the pre auth. The last Mike mentioned it he said they could not get it removed for 2024 but 2025 should be the year. In the spirit of the 60th anniversary of JFK lets Zapruder Stevil's statement - he said -"only about 15% of my patients were on medicaid and about 65% were commercially insured the last time I ran a report". So, only 20% or less would be on Medicare. I am not sure what to make of this nor the Zapruder film. What I have pushed and what Mike came to appreciate in 2023 was the importance of Medicare in selling afrezza and at $35 that should solve the cost issue. |
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Post by sayhey24 on Nov 22, 2023 16:18:08 GMT -5
Aged - as I framed my question to Stevil "our patients were seeing a 0.4-0.5% lower A1c when using afrezza than using what - Mounjaro?" Immediately after this he starts talking about Mounjaro and how he has many patients using it. Lets let Stevil answer what he is comparing afrezza to. ... Read the passage like an English comprehension test. It's crystal clear. Let's let Stevil answer the question unless you know what he is comparing afrezza to. Since you say its crystal clear what is he comparing afrezza to? I don't know. Metformin? Farxiga? Ozempic? What? Here is his statement in context - "Half of my patients quit Afrezza on their own. The biggest issue was it was too much work to babysit their CGM with Afrezza. They got excellent results- they admitted as much. They just got tired of having to dose so many times a day when they could get 0.4-0.5% higher A1c with less than half the effort. Cost wasn't the issue for most of them." |
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Post by prcgorman2 on Nov 22, 2023 16:24:59 GMT -5
Great info. So the $99 a month is still too high for many patients. I wonder if MannKind could renegotiate to say, $50 a month or even $25 a month through Eagle if that would help. I’m assuming many of these patients are low income/poverty and that $99 a month is a lot for them. We have to do better! Medicare is $35 but again for 2024 pre auths are required. About 50% of T2s are on Medicare. Thats the market MNKD needs to target. They also get a nearly free CGM if they are using afrezza and don't let anyone tell you DXCM and Abbott are not aware of this. The problem is the pre auth. The last Mike mentioned it he said they could not get it removed for 2024 but 2025 should be the year. In the spirit of the 60th anniversary of JFK lets Zapruder Stevil's statement - he said -"only about 15% of my patients were on medicaid and about 65% were commercially insured the last time I ran a report". So, only 20% or less would be on Medicare. I am not sure what to make of this nor the Zapruder film. What I have pushed and what Mike came to appreciate in 2023 was the importance of Medicare in selling afrezza and at $35 that should solve the cost issue. I'm getting confused. stevil said, "medicaid". medicaid and medicare are not the same.
Per the info at URL (https://www.medicare.gov/basics/costs/help/medicaid), "Medicaid is a joint federal and state program that helps cover medical costs for some people with limited income and resources. Medicaid offers benefits not normally covered by Medicare, like nursing home care and personal care services. The rules around who’s eligible for Medicaid are different in each state."
medicaid is government-backed insurance for low-income people and is at least partially administered by state governments, and medicare is for 65 and older and is administered by the Federal government. The coverages and procedures are not the same so I got lost in the discussion on percentages of people being covered and how that relates to marketing of Afrezza.
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Post by sayhey24 on Nov 22, 2023 17:17:33 GMT -5
Why are you confused - medicaid is for those financially challenged - in the old days we called them poor. Medicare is for those 65+ in age regardless of financial position. Part A is free, Part B costs but depends on financial ability. Part D costs but many sign up for Part C which may not cost and can include Part D and other perks like silver sneakers. There are about 66M on Medicare and 20% are T2 diabetics. Thats a big number.
Stevil did not mention Medicare. I did and thats where I got at most 20% could be on Medicare which seems really low and my comment about Zaprudering the comment. The more I watch that film the more things don't add up especially if you watch the digital one with the additional film between the frames added back in.
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Post by sayhey24 on Nov 22, 2023 17:34:20 GMT -5
When Bill and Stevil mention cost being a major factor in discontinuation of Afrezza, I am just curious if these people did not qualify for the Afrezza Savings Card copay can be as low as $15-$35. Or Eagle Pharmacy savings program that is $99 for 1 month of 90 carts or $199 for 1 months of 180 carts. Did both VDex and Stevil use these services? If not, why not? If so, what went wrong? stevil sportsrancho Bill will get back to you in a bit. I see Nate a little troubled by all this🤷♀️ Bill doesn’t know what’s going on on social media. He does know what’s going on with Afrezza. That’s the info he is trying to provide. Sports - what does this mean "I see Nate a little troubled by all this"? Why is he troubled? |
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Post by sportsrancho on Nov 22, 2023 19:54:55 GMT -5
Bill will get back to you in a bit. I see Nate a little troubled by all this🤷♀️ Bill doesn’t know what’s going on on social media. He does know what’s going on with Afrezza. That’s the info he is trying to provide. Sports - what does this mean "I see Nate a little troubled by all this"? Why is he troubled? I’m not sure, he seems to get on here and read and Cherry pick things to talk about on Stocktwits. If he mention's Vdex, somebody sends me his posts. He said Bill doesn’t seem to know what’s going on on Pro-Boards or social media with the VDex and Friend‘s gang. There is no VDex and friends. It’s just me. Also about Pro-Boards being prejudiced, and letting the shorts on here. I think it had to do with this whole conversation. but most of it didn’t pertain to VDex so it’s unclear …..because it was you, aged and Stevil posting. |
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Post by stevil on Nov 22, 2023 23:37:45 GMT -5
When Bill and Stevil mention cost being a major factor in discontinuation of Afrezza, I am just curious if these people did not qualify for the Afrezza Savings Card copay can be as low as $15-$35. Or Eagle Pharmacy savings program that is $99 for 1 month of 90 carts or $199 for 1 months of 180 carts. Did both VDex and Stevil use these services? If not, why not? If so, what went wrong? stevil sportsranchoMannkind has a very generous coupon card. If a patients insurance covers it, it’s never more than $35/month unless you order 5+ boxes a month. At that point, the patient isn’t a good candidate for Afrezza, at least not until they create an aero chamber for it where you can just let them inhale their dose over several minutes 🤣 I don’t recall the specifics but the maximum coverage is very high. So for people with high deductible plans with 💩 for pharmacy benefits (although those plans would then never cover Afrezza), the coupon card essentially absorbs the entire cost of the prescription and leaves just a $35 copay for it- as long as you send it through the specialty pharmacy. UBC automatically applies it for patients. Retail pharmacies don’t- they’d need to get the coupon card from their doctor or online. Idk who sends it to retail though. It’s way more convenient to just go through UBC. You do the prior auth on their website and then it gets shipped directly to the patient |
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Post by stevil on Nov 23, 2023 0:13:16 GMT -5
Stevil - are you breaking major news here? Did you just say your patients were seeing a 0.4-0.5% lower A1c when using afrezza than using what - Mounjaro? I am not sure what you are comparing afrezza to but if it’s GLP1s that is HUGE news. Can you clarify, please. Mike mentioned awhile back that the India trial could show results on par to GLP1s but 1/2% more is very significant if a head to head trial was done between afrezza and Ozempic/Mounjarno. Ah! The one time I don’t expect you to actually take my words for gospel you go and surprise me! I don’t actually compile the data and compare A1cs. Just off memory, the patients that stop Afrezza tend to get a higher A1c once they stop. Not all, but more than half. A lot of the patients that stopped were already on MDI and either replaced humalog/novalog with Afrezza entirely or just used it for corrections. These people were functionally type 1s because they were on basal/bolus as well as metformin, Jardiance, and trulicity. So it’s not really all that impressive. They could sneeze and their sugars would jump to the 300s. This is why they quit. I was really disappointed in one of them. He had been diabetic for a long time and he was almost in tears and thanked me for putting him on it after the 1 month follow up. He was a nurse and was one of the first people I felt comfortable enough to start on Afrezza. Maybe (probably) I’m still using training wheels, but Afrezza is much harder to use in advanced diabetes beyond just the inhalation count/cough aspect. You (the patient) actually have to understand diabetes and how your body responds to stress, exercise, high vs low glycemic foods, etc. because it is so precise and works so quickly, it takes a lot more monitoring. Humalog/novolog are a little easier because they’re so blunt. You aren’t trying to hit the bullseye, you’re just hoping to get close to the target. Anyway, to answer your question, as with all things diabetes, it really depends on the patient. I have had patients that put their diabetes into remission with just diet and exercise after having an A1c of 11. I’ve seen it many times with metformin as well. Putting diabetes into remission really isn’t that impressive for a good number of patients. It’s definitely not unique to Afrezza. It depends on where they are in their disease and how poor their health and habits are. I guess I haven’t answered the question yet. Hard to give thoughtful responses on a phone. In general the improvement was on people with advanced diabetes on MDI. There were a few with Ozempic. But generally, Afrezza was used in addition to the GLP-1s for postprandial corrections. And to be fair, I have had patients trade their Afrezza for Mounjaro and get over 1 A1c better. This goes back to my previous post to you. It wasn’t because Afrezza wasn’t working well- I gave them a tool they didn’t want to use. they just missed doses because they didn’t want to do it multiple times a day. |
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Post by stevil on Nov 23, 2023 0:27:06 GMT -5
From Bill… “ I’ll confine my comments to Stevil’s recent post and our experience with Afrezza. In overview, I can confirm much of his experience with Afrezza. We at VDex have had many patients drop but it was almost always over the cost. Given Afrezza’s tier placement on most plans (if it’s even on formulary at all) it’s just not affordable for most people. Aside from the cost there is a learning curve with the use of Afrezza. As I may have said before we use the analogy of riding a bike. You don’t just give a kid a bike and tell him to go learn to ride. He’ll never do it. A parent puts the kid on the bike holds on to the bike to steady it till the child gains enough confidence to ride off on his own. Same with Afrezza. You’ve got to hold patients’ hand in the early stage and that is the reason for CGM. I don’t want to misinterpret Stevil but it sounds like many of his patients drop because of the hassle factor with CGM and multiple dosing per day. I’m not surprised by that. To enjoy wide acceptance among Type 2s (93% of the market) a therapy has to be cheap, easy, convenient, safe and MUST NOT make the patient feel lousy. Afrezza checks all those boxes AFTER getting past the learning curve, EXCEPT cheap. The multiple dosing and hassles with CGM really is part of the learning curve. We at VDex used to do multiple dosing, especially post-prandially. We don’t anymore because again, it’s a hassle. The better strategy we’ve found is to dose higher at the mealtime (because you really don’t need to worry about lows) and not worry about follow up dosing. There’s such a wide safety margin with the drug that If one doses 24 units instead of say 18, the patient won’t have a problem. The key is to dose the meal aggressively then forget it. You won’t need follow up doses. Less hassle. The only real problem with this approach is that it involves inhaling more powder and can cause a cough. Regarding CGM, we don’t use it continuously again because of hassle. The therapy needs to be easy. So CGM is used during learning phase (learning to ride the bike). Then forget it until perhaps annual assessment of patients’ BG profile. Once patients learn that they have three inhalations per day at mealtimes and NOTHING ELSE, they’re happy and compliance goes up. Last point, despite the popularity of Ozempic and similar drugs, they can’t compare to Afrezza. Not even close. It’s just that use of Afrezza is different and one has to learn. But then wasn’t bike-riding the same? And didn’t we all learn?” This is a unique challenge to Afrezza that MNKD needs to figure out how to solve. But it takes A LOT of resources to do it. I’m pretty sure I’ve understood Bill to say it’s taken a long time to dial in the secret sauce for Afrezza. The problem is, he had to teach himself. I’m having to teach myself with my patients. It’s hard for your patients to hear that you’re learning as they’re learning. It’s also hard to hold their hand when you have such limited access to care. Like I said, I’m booked out anywhere from 4-6 weeks minimum at my clinic. I wish I could hold my patients hand while they’re learning to ride the bike. This problem isn’t unique to my clinic- we’re actually much more accessible than many other practices in my area. Most are out 3 months. Afrezza demands very close initial follow up. There need to be clinics like VDEX that are dedicated to this training- or nurse educators from MNKD that can support this transition. Ultimately, I only had one patient quit out of sheer confusion /frustration. He was a fairly new diabetic and he was still trying to learn how to use novolog/humalog. In hindsight, I set him up for failure because he was still in the learning phase of those and then I tried to switch him to Afrezza. It confused the hell out of him- he had to unlearn everything he’d just learned and it was frustrating so he gave up and went back to novolog/humalog. His CGM looked like a sine wave bouncing up and down because I think he was overdosing on Afrezza, panicking because his CGM was freaking out because his sugar was dropping so quickly so he’d correct with sugar and do it all over again. MNKD has been trying and they now do offer an educator. This started at the beginning of this year. I take as much time as I can with my patients, but it’s incredibly difficult to train someone on the nuances of Afrezza in 20 minutes. |
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Post by peppy on Nov 23, 2023 1:59:36 GMT -5
I don't have diabetes, but I can't imagine having a pump to wear all day being less of a hassle then a quick inhale when needed. The pump seems like a much bigger management issue. If I did have diabetes I know I would much prefer a CGM and Afrezza as it seems so much less burdensome. I can't speak from actual experience, but I know what would be my choice if I did have to make it. There might be times when I'd inhale in the mens room rather than in public, but if I had to inhale in public that wouldn't be an issue for me personally. Aged is an expert on diabetes and treatment options. The Omnipod 5. www.omnipod.com/what-is-omnipod/omnipod-5Aged pointed out to me years ago, it is a miniature auto syringe that can be digitally programed. Computerized now with a Continuous glucose monitor as the feed back system. mpg54 , the real upside in Afrezza is the delivery system, into the left atrium, left ventricle and systemic blood stream allows for 35 min peak time and 90 min out of the system for a 4 unit cartridge. *if blood glucose level is over 100 at 60 mins a second dose of afrezza may be necessary. the omnipod because the delivery is subcutaneous, Peak is two hours and it takes 5 hours to get out of the system as the delivery is through the capillaries to the blood stream a slow go. . One more thing about Afrezza. Afrezza dosing allows for, "permits insulin to find its way into the portal circulation readily and to undergo the first-pass metabolism in the liver subsequently." stevil, when he was still in medical school was the first to tell me about first pass. First pass stops the liver from releasing glucose. 1. subcutaneous insulin does not have a first pass. 2. first pass is probably the reason Afrezza is able to keep the initial blood glucose levels in check with meals, or said differently, why the post meal blood glucose levels are lower with afrezza than subq. . |
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Post by lennymnkd on Nov 23, 2023 9:06:53 GMT -5
Peppy . I thought Afrezza avoided first pass hepatic metabolism to its advantage 🤔?
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Post by prcgorman2 on Nov 23, 2023 11:16:55 GMT -5
I’ll speculate about the first pass but that’s all I’m doing so please don’t shoot the messenger. There is a dance that goes on between the pancreas and the liver, and the place where insulin first enters the blood from the pancreas is the hepatic artery straight into the liver. It’s like ringing the dinner bell in terms of a “signal” to the liver. Because Afrezza enters the blood within a couple of seconds of being inhaled, it is able to mimic, to some degree, the dinner bell signal to the liver. Because RAA is absorbed more slowly from the subcutaneous tissue of the injection site, and because RAA has to be chemically rearranged by the body’s chemistry to become the sort of insulin the body can actually use, the dinner bell signal is too muted. Apologies to everyone for such a poor lay person’s explanation.
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Post by sportsrancho on Nov 23, 2023 12:23:34 GMT -5
From Bill… “ I’ll confine my comments to Stevil’s recent post and our experience with Afrezza. In overview, I can confirm much of his experience with Afrezza. We at VDex have had many patients drop but it was almost always over the cost. Given Afrezza’s tier placement on most plans (if it’s even on formulary at all) it’s just not affordable for most people. Aside from the cost there is a learning curve with the use of Afrezza. As I may have said before we use the analogy of riding a bike. You don’t just give a kid a bike and tell him to go learn to ride. He’ll never do it. A parent puts the kid on the bike holds on to the bike to steady it till the child gains enough confidence to ride off on his own. Same with Afrezza. You’ve got to hold patients’ hand in the early stage and that is the reason for CGM. I don’t want to misinterpret Stevil but it sounds like many of his patients drop because of the hassle factor with CGM and multiple dosing per day. I’m not surprised by that. To enjoy wide acceptance among Type 2s (93% of the market) a therapy has to be cheap, easy, convenient, safe and MUST NOT make the patient feel lousy. Afrezza checks all those boxes AFTER getting past the learning curve, EXCEPT cheap. The multiple dosing and hassles with CGM really is part of the learning curve. We at VDex used to do multiple dosing, especially post-prandially. We don’t anymore because again, it’s a hassle. The better strategy we’ve found is to dose higher at the mealtime (because you really don’t need to worry about lows) and not worry about follow up dosing. There’s such a wide safety margin with the drug that If one doses 24 units instead of say 18, the patient won’t have a problem. The key is to dose the meal aggressively then forget it. You won’t need follow up doses. Less hassle. The only real problem with this approach is that it involves inhaling more powder and can cause a cough. Regarding CGM, we don’t use it continuously again because of hassle. The therapy needs to be easy. So CGM is used during learning phase (learning to ride the bike). Then forget it until perhaps annual assessment of patients’ BG profile. Once patients learn that they have three inhalations per day at mealtimes and NOTHING ELSE, they’re happy and compliance goes up. Last point, despite the popularity of Ozempic and similar drugs, they can’t compare to Afrezza. Not even close. It’s just that use of Afrezza is different and one has to learn. But then wasn’t bike-riding the same? And didn’t we all learn?” This is a unique challenge to Afrezza that MNKD needs to figure out how to solve. But it takes A LOT of resources to do it. I’m pretty sure I’ve understood Bill to say it’s taken a long time to dial in the secret sauce for Afrezza. The problem is, he had to teach himself. I’m having to teach myself with my patients. It’s hard for your patients to hear that you’re learning as they’re learning. It’s also hard to hold their hand when you have such limited access to care. Like I said, I’m booked out anywhere from 4-6 weeks minimum at my clinic. I wish I could hold my patients hand while they’re learning to ride the bike. This problem isn’t unique to my clinic- we’re actually much more accessible than many other practices in my area. Most are out 3 months. Afrezza demands very close initial follow up. There need to be clinics like VDEX that are dedicated to this training- or nurse educators from MNKD that can support this transition. Ultimately, I only had one patient quit out of sheer confusion /frustration. He was a fairly new diabetic and he was still trying to learn how to use novolog/humalog. In hindsight, I set him up for failure because he was still in the learning phase of those and then I tried to switch him to Afrezza. It confused the hell out of him- he had to unlearn everything he’d just learned and it was frustrating so he gave up and went back to novolog/humalog. His CGM looked like a sine wave bouncing up and down because I think he was overdosing on Afrezza, panicking because his CGM was freaking out because his sugar was dropping so quickly so he’d correct with sugar and do it all over again. MNKD has been trying and they now do offer an educator. This started at the beginning of this year. I take as much time as I can with my patients, but it’s incredibly difficult to train someone on the nuances of Afrezza in 20 minutes. From Bill…”Great back and forth. You’re absolutely right about how confusing this all is and the difficult environment that Mannkind is up against.” “The average doc just says to hell with it and goes back to what he knows. Another couple key points: The number of endocrinologists is falling; not enough coming out of med schools to even keep constant numbers in med community. Hospitals are recruiting all over the world for them which is why so many are foreigners. At the same time as endos are getting more scarce, patients needing endos, principally diabetes patients, is exploding. Hence most diabetes is being managed by PCPs like Stevil. There’s literally no one else to see them. PCPs’ schedules are crushed. Stevil says as much when he mentions spending time with patients teaching about Afrezza. He says 20 min ISNT ENOUGH time. Most PCPs I’ve spoken to don’t even get 20 min with each patient. More like 10-15 tops. And many are doing 7-10 min. Remember PCP practices are increasing owned by hospitals and hospitals want the practice to run patients through. That makes them more money. PCPs have guidelines they’re supposed to meet with financial incentives. So what happens? They just cannot give the diabetes patients the time they need to properly use Afrezza. Afrezza will always struggle in that environment. So, the answer is specific Afrezza clinics. Last point: Afrezza should be a PRIMARY glucose lowering agent NOT AN ADJUNCT. But that’s not how docs are taught. Prandial insulin is treated as adjunct yet diabetes is first and foremost a prandial problem. So why not use a prandial solution to a prandial problem? That makes all the difference.” |
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Post by lennymnkd on Nov 23, 2023 13:19:59 GMT -5
Sports , type one or two is a bad brake in life no doubt. But a CGM SEEMS TO BE A SMAAL PRICE TO PAY
for some piece of mind health wise . I have two close friends (type 2) who use the libre while I’m out with them .
(Ozempic ) they don’t seem annoyed the least bit with an occasional buzz and do a fast swip …
Often showing me their time in range on their phone .. doesn’t seen like it can get any easier.
I know there has been a ton of discussion on this but I still don’t get it. That monitoring of numbers seems to be a
Big piece of the pie .. you would think Afrezza/ CGM / and maybe a once a week basal would VEDEX’s golden ticket
Of course marketing..and finance wouldn’t hurt . I’m the Afrezza advertising advocate from way back 😉
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Post by sayhey24 on Nov 27, 2023 14:48:03 GMT -5
Stevil - are you breaking major news here? Did you just say your patients were seeing a 0.4-0.5% lower A1c when using afrezza than using what - Mounjaro? I am not sure what you are comparing afrezza to but if it’s GLP1s that is HUGE news. Can you clarify, please. Mike mentioned awhile back that the India trial could show results on par to GLP1s but 1/2% more is very significant if a head to head trial was done between afrezza and Ozempic/Mounjarno. Ah! The one time I don’t expect you to actually take my words for gospel you go and surprise me! I don’t actually compile the data and compare A1cs. Just off memory, the patients that stop Afrezza tend to get a higher A1c once they stop. Not all, but more than half. A lot of the patients that stopped were already on MDI and either replaced humalog/novalog with Afrezza entirely or just used it for corrections. These people were functionally type 1s because they were on basal/bolus as well as metformin, Jardiance, and trulicity. So it’s not really all that impressive. They could sneeze and their sugars would jump to the 300s. This is why they quit. I was really disappointed in one of them. He had been diabetic for a long time and he was almost in tears and thanked me for putting him on it after the 1 month follow up. He was a nurse and was one of the first people I felt comfortable enough to start on Afrezza. Maybe (probably) I’m still using training wheels, but Afrezza is much harder to use in advanced diabetes beyond just the inhalation count/cough aspect. You (the patient) actually have to understand diabetes and how your body responds to stress, exercise, high vs low glycemic foods, etc. because it is so precise and works so quickly, it takes a lot more monitoring. Humalog/novolog are a little easier because they’re so blunt. You aren’t trying to hit the bullseye, you’re just hoping to get close to the target. Anyway, to answer your question, as with all things diabetes, it really depends on the patient. I have had patients that put their diabetes into remission with just diet and exercise after having an A1c of 11. I’ve seen it many times with metformin as well. Putting diabetes into remission really isn’t that impressive for a good number of patients. It’s definitely not unique to Afrezza. It depends on where they are in their disease and how poor their health and habits are. I guess I haven’t answered the question yet. Hard to give thoughtful responses on a phone. In general the improvement was on people with advanced diabetes on MDI. There were a few with Ozempic. But generally, Afrezza was used in addition to the GLP-1s for postprandial corrections. And to be fair, I have had patients trade their Afrezza for Mounjaro and get over 1 A1c better. This goes back to my previous post to you. It wasn’t because Afrezza wasn’t working well- I gave them a tool they didn’t want to use. they just missed doses because they didn’t want to do it multiple times a day. Say what! Come on Man! I always take your words for gospel but there are a lot of things going on with diabetes. Its more of an engineering "fluid control " problem with many valves. So your answer was "crystal clear"! There are different situations and you have your hands full and you are still learning. At the same time I think you broke some news. Mike has mentioned in the past the afrezza/Ozempic trial. The fact is GLP1s are not going away and IF afrezza can show a further 0.5% reduction in a trial those are more than bragging rights and would provide another point of leverage to make changes to the SoC. In your world you have PWDs on all kinds of meds. A controlled trial would provide a more stable environment. Mounjaro reported that with a baseline A1C of 7.9% to 8.6% that 90% of people taking Mounjaro 10-mg plus basal insulin achieved an A1C of under 7%. Lets see if Mike comes up with something for a trial. I am sure we don't want people using basal insulin, just head to head afrezza/Mounjaro and Ozempic. I am sure you are aware that when VDex gets these people on all kinds of meds they try and gets them off all of it over time except afrezza. Maybe Bill has a paper on this he can share. |
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