Pharmacologic Approaches to Glycemic Treatment: Standards of

[harryx1]

diabetesjournals.org/care/article/47/Supplement_1/S158/153955/9-Pharmacologic-Approaches-to-Glycemic-Treatment

9. Pharmacologic Approaches to Glycemic Treatment: Standards of Care in Diabetes—2024


Pharmacologic Therapy for Adults With Type 1 Diabetes

Recommendations

9.1 Treat most adults with type 1 diabetes with continuous subcutaneous insulin infusion or multiple daily doses of prandial (injected or inhaled) and basal insulin. A



9.2 For most adults with type 1 diabetes, insulin analogs (or inhaled insulin) are preferred over injectable human insulins to minimize hypoglycemia risk. A



9.3 Early use of continuous glucose monitoring is recommended for adults with type 1 diabetes to improve glycemic outcomes and quality of life and minimize hypoglycemia. B



9.4 Automated insulin delivery systems should be considered for all adults with type 1 diabetes. A



9.5 To improve glycemic outcomes and quality of life and minimize hypoglycemia risk, most adults with type 1 diabetes should receive education on how to match mealtime insulin doses to carbohydrate intake and, additionally, to fat and protein intake. They should also be taught how to modify the insulin dose (correction dose) based on concurrent glycemia, glycemic trends (if available), sick-day management, and anticipated physical activity. B



9.6 Glucagon should be prescribed for all individuals taking insulin or at high risk for hypoglycemia. Family, caregivers, school personnel, and others providing support to these individuals should know its location and be educated on how to administer it. Glucagon preparations that do not require reconstitution are preferred. E



9.7 Insulin treatment plan and insulin-taking behavior should be reevaluated at regular intervals (e.g., every 3–6 months) and adjusted to incorporate specific factors that impact choice of treatment and ensure achievement of individualized glycemic goals. E

[sayhey24]

I think Mike and team have not been doing a very good job influencing the SoC.  Maybe next year?

Table 9.4 alone demonstrates why no doctor is going to prescribe afrezza.  It is nearly 10x other alternatives and nearly 4x the next most costly insulin option.  No one from MNKD told them they can get it for $99 A MONTH with no coupon.


Table 9.4

Median cost of insulin products in the U.S. calculated as AWP and NADAC per 1,000 units of specified dosage form/product - afrezza $1503
Next most costly - $424

Even the GLP1s are listed cheaper at $991.

[agedhippie]

Dec 11, 2023 14:55:39 GMT -5 sayhey24 said:

I think Mike and team have not been doing a very good job influencing the SoC.  Maybe next year?

Table 9.4 alone demonstrates why no doctor is going to prescribe afrezza.  It is nearly 10x other alternatives and nearly 4x the next most costly insulin option.  No one from MNKD told them they can get it for $99 A MONTH with no coupon.
...

The problem you hit with 9.4 is that A at the end of the line. That A is the evidence category and A is as high as you can score. To do that there have to be multiple large scale trials with demonstrably superior outcomes. The pump manufacturers have done the work to produce the evidence, Mannkind hasn't and what you see is the result. This has nothing to do with cost (have you seen the price of a Medtronic pump?) and everything to do with trial data.