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Post by sayhey24 on Aug 2, 2024 11:10:11 GMT -5
... Look, there is nothing better to demonstrate the power of a CGM than afrezza. Inhale-3 proved that. With the CGM and afrezza the PWD can make real-time corrections. They are not looking in the rear-view mirror. They have forward looking radar with afrezza. This is irrelevant to the CGM manufacturers. They have demonstrated the benefit of CGMs for insulin users in clinical trials to the satisfaction of the insurers and Medicare. At this point they have made the sale as anyone on insulin can have a CGM covered by insurance or Medicare. They have moved on to non-insulin users and are build their case there, so revisiting insulin has no value to them. Thats OK for afrezza too. What the CGMs will show is GLP1s do not stop the post meal spike. Anything which will help sell afrezza and help PWDs I am all for. Mike needs to be doing the afrezza/glp1 study asap. The thing is I am pretty sure he knows it too. Blevin mentioned he has no active studies now so what better time? I was surprised from the Blevin interview that LADAs are going on GLP1s and off insulin but are struggling with the post meal spike. Sounds like they need to add afrezza to me. Worldwide the LADA market is estimated to be between 17 to 50 million so thats a lot of afrezza. |
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Post by prcgorman2 on Aug 2, 2024 12:25:11 GMT -5
This is irrelevant to the CGM manufacturers. They have demonstrated the benefit of CGMs for insulin users in clinical trials to the satisfaction of the insurers and Medicare. At this point they have made the sale as anyone on insulin can have a CGM covered by insurance or Medicare. They have moved on to non-insulin users and are build their case there, so revisiting insulin has no value to them. Thats OK for afrezza too. What the CGMs will show is GLP1s do not stop the post meal spike. Anything which will help sell afrezza and help PWDs I am all for. Mike needs to be doing the afrezza/glp1 study asap. The thing is I am pretty sure he knows it too. Blevin mentioned he has no active studies now so what better time? I was surprised from the Blevin interview that LADAs are going on GLP1s and off insulin but are struggling with the post meal spike. Sounds like they need to add afrezza to me. Worldwide the LADA market is estimated to be between 17 to 50 million so thats a lot of afrezza. The "forward looking radar" really isn't forward looking. It's still looking at information over time and providing a snapshot of what was, and not what is to be. Think of a better analogy.
But, I think I see what you're getting at sayhey24 which is the user of a CGM can see what has happened (in the past) to their blood sugar levels, and can anticipate what the BG levels should look like if they do nothing, or if they take a corrective action, such as inhaling a cartridge of Afrezza.
Over time (days, weeks, not seconds, minutes) the CGM user can get comfortable understanding how their body reacts to foods with or without GLP1 and with or without Afrezza, and better manage their BG level "time in range".
It is a muscle memory kind of behavior based on anticipating where the BG is going next based on the person, what they've eaten, and what medication(s) they're using, and they're ability to monitor the reactions accordingly.
agedhippie - I think the business case for the CGM manufacturers to "rep" Afrezza is people are impatient and they want to see results in less time than it takes to watch an episode of Seinfeld. People will be too distracted and too frustrated to try that with GLP1 or RAA.
Afrezza let's CGM users see results in near(er)-real-time. "Rep"ing Afrezza with/for CGMs should be easy to do a small market pilot without needing a single study. Am I missing something?
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Post by ktim on Aug 2, 2024 12:46:48 GMT -5
Perhaps missing that companies that sell CGMs aren't going to set sales goals for another company's product ??
Granted I only have one career's worth of experience, but I've never encountered that arrangement.
And there is also the thing that lack of sales reps has never been the problem with Afrezza. If all we needed was "rep"ing, MNKD could just hire them... especially now that we are profitable.
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Post by prcgorman2 on Aug 2, 2024 12:51:30 GMT -5
Perhaps missing that companies that sell CGMs aren't going to set sales goals for another company's product ?? Granted I only have one career's worth of experience, but I've never encountered that arrangement. And there is also the thing that lack of sales reps has never been the problem with Afrezza. If all we needed was "rep"ing, MNKD could just hire them... especially now that we are profitable. What is the measure CGM manufacturers use to set sales goals? Is it a simple trend of what they've been able to sell? Or do they look for strategies that help them expand how many CGMs are in use?
The CGM sales people have never had a tool to be able to show anyone in as much time as it takes to do a sales call, the wonder of their product.
I'm not sure how practical it would be, but I would want to start the sales call by chugging a coke, wait 15 minutes, and then inhale a cartridge of Afrezza. You might be able to accomplish a visible spike, and reduction, in less than 30 minutes. Certainly within 1 hour. (Hopefully I wouldn't have more than 2 sales calls in a day.  |
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Post by sayhey24 on Aug 2, 2024 13:04:42 GMT -5
Thats OK for afrezza too. What the CGMs will show is GLP1s do not stop the post meal spike. Anything which will help sell afrezza and help PWDs I am all for. Mike needs to be doing the afrezza/glp1 study asap. The thing is I am pretty sure he knows it too. Blevin mentioned he has no active studies now so what better time? I was surprised from the Blevin interview that LADAs are going on GLP1s and off insulin but are struggling with the post meal spike. Sounds like they need to add afrezza to me. Worldwide the LADA market is estimated to be between 17 to 50 million so thats a lot of afrezza. The "forward looking radar" really isn't forward looking. It's still looking at information over time and providing a snapshot of what was, and not what is to be. Think of a better analogy.
But, I think I see what you're getting at sayhey24 which is the user of a CGM can see what has happened (in the past) to their blood sugar levels, and can anticipate what the BG levels should look like if they do nothing, or if they take a corrective action, such as inhaling a cartridge of Afrezza.
Over time (days, weeks, not seconds, minutes) the CGM user can get comfortable understanding how their body reacts to foods with or without GLP1 and with or without Afrezza, and better manage their BG level "time in range".
It is a muscle memory kind of behavior based on anticipating where the BG is going next based on the person, what they've eaten, and what medication(s) they're using, and they're ability to monitor the reactions accordingly.
agedhippie - I think the business case for the CGM manufacturers to "rep" Afrezza is people are impatient and they want to see results in less time than it takes to watch an episode of Seinfeld. People will be too distracted and too frustrated to try that with GLP1 or RAA.
Afrezza let's CGM users see results in near(er)-real-time. "Rep"ing Afrezza with/for CGMs should be easy to do a small market pilot without needing a single study. Am I missing something?
I bought my first Libre on ebay before they were available in the U.S. After a month I really did not need it anymore because I had a pretty great idea what food was going to do what. Then again I am not a T1. I would think it would be the same with the GLP1 users. More important aside from eating something different the next time there is nothing the GLP1 user can do. With afrezza you can take another hit real-time and stop the spike - i.e. forward looking radar. I don't know if they will get Medicare to pay for the CGMs with GLP1 users. I see little benefit but its all about Abbott selling Libres. I am sure they have all kinds of studies showing amazing benefits but in real life, I don't see it. What I do see is the CGM will highlight the spike and need for afrezza. Afrezza when you are not taking other meds is very forgiving as the liver will prevent any lows and prevent the hypos. I don't know how much the GLP1 would be messing up the liver by preventing glycogen secretion when using afrezza. We need some trials. |
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Post by agedhippie on Aug 2, 2024 13:30:23 GMT -5
Perhaps missing that companies that sell CGMs aren't going to set sales goals for another company's product ?? Granted I only have one career's worth of experience, but I've never encountered that arrangement. And there is also the thing that lack of sales reps has never been the problem with Afrezza. If all we needed was "rep"ing, MNKD could just hire them... especially now that we are profitable. What is the measure CGM manufacturers use to set sales goals? Is it a simple trend of what they've been able to sell? Or do they look for strategies that help them expand how many CGMs are in use?
The CGM sales people have never had a tool to be able to show anyone in as much time as it takes to do a sales call, the wonder of their product.
I'm not sure how practical it would be, but I would want to start the sales call by chugging a coke, wait 15 minutes, and then inhale a cartridge of Afrezza. You might be able to accomplish a visible spike, and reduction, in less than 30 minutes. Certainly within 1 hour. (Hopefully I wouldn't have more than 2 sales calls in a day. The issue is that the CGM salesman is there to sell a tool, not change diabetes treatments (that's the endos' job). The endo is going to prescribe that CGM regardless if the patient is on insulin. There is no up side for the CGM vendor in presenting Afrezza. |
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Post by agedhippie on Aug 2, 2024 13:40:37 GMT -5
... I don't know if they will get Medicare to pay for the CGMs with GLP1 users. I see little benefit but its all about Abbott selling Libres. I am sure they have all kinds of studies showing amazing benefits but in real life, I don't see it. What I do see is the CGM will highlight the spike and need for afrezza. ... To the best of my knowledge Medicare will not cover CGMs for non-insulin users although some insurers will. Abbott are already presenting their finding showing the benefit of CGMs for GLP-1 users at international conferences. I remember you saying there is no way Medicare will ever cover CGMs for basal insulin using T2 just before Medicare approved exactly that. That was also all driven by trial data. |
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Post by ktim on Aug 2, 2024 13:58:07 GMT -5
I'm not sure how practical it would be, but I would want to start the sales call by chugging a coke, wait 15 minutes, and then inhale a cartridge of Afrezza. You might be able to accomplish a visible spike, and reduction, in less than 30 minutes. Certainly within 1 hour. (Hopefully I wouldn't have more than 2 sales calls in a day. I sure wouldn't want to be a sales rep working at your company if you made Naloxone  |
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Post by sayhey24 on Aug 2, 2024 15:05:19 GMT -5
What is the measure CGM manufacturers use to set sales goals? Is it a simple trend of what they've been able to sell? Or do they look for strategies that help them expand how many CGMs are in use?
The CGM sales people have never had a tool to be able to show anyone in as much time as it takes to do a sales call, the wonder of their product.
I'm not sure how practical it would be, but I would want to start the sales call by chugging a coke, wait 15 minutes, and then inhale a cartridge of Afrezza. You might be able to accomplish a visible spike, and reduction, in less than 30 minutes. Certainly within 1 hour. (Hopefully I wouldn't have more than 2 sales calls in a day. The issue is that the CGM salesman is there to sell a tool, not change diabetes treatments (that's the endos' job). The endo is going to prescribe that CGM regardless if the patient is on insulin. There is no up side for the CGM vendor in presenting Afrezza. Most T2s don't go to endo's. The upside for the Abbotts is they need insulin prescribed to get the CGM sale. Afrezza fits nice with the PCP as there is little fear with hypos and no needles. Afrezza is just too damn expensive right now which insurance can fix. |
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Post by sayhey24 on Aug 2, 2024 15:13:43 GMT -5
... I don't know if they will get Medicare to pay for the CGMs with GLP1 users. I see little benefit but its all about Abbott selling Libres. I am sure they have all kinds of studies showing amazing benefits but in real life, I don't see it. What I do see is the CGM will highlight the spike and need for afrezza. ... To the best of my knowledge Medicare will not cover CGMs for non-insulin users although some insurers will. Abbott are already presenting their finding showing the benefit of CGMs for GLP-1 users at international conferences. I remember you saying there is no way Medicare will ever cover CGMs for basal insulin using T2 just before Medicare approved exactly that. That was also all driven by trial data. We are talking T2s on Medicare for Abbott. That is their focus not the broader market for now. As I said before they had the studies ready to go with icodec buts thats DOA now. Right now Mike is not doing a damn thing. I hope I find out different next week but right now we are not aware of a deal or trial for afrezza with T2s except Inhale-2 and I have no idea what happened with that. If Abbott can get Medicare to pay for CGMs with GLP1s, thats great news. What everyone will see is GLP1 users have a huge post meal BG spike issue. This is the afrezza/glp1 adder study I have been asking for. The only way to stop the spike is afrezza. Maybe Abbott will get done what Mike has not. |
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Post by agedhippie on Aug 2, 2024 15:43:52 GMT -5
The issue is that the CGM salesman is there to sell a tool, not change diabetes treatments (that's the endos' job). The endo is going to prescribe that CGM regardless if the patient is on insulin. There is no up side for the CGM vendor in presenting Afrezza. Most T2s don't go to endo's. The upside for the Abbotts is they need insulin prescribed to get the CGM sale. Afrezza fits nice with the PCP as there is little fear with hypos and no needles. Afrezza is just too damn expensive right now which insurance can fix. PCPs will follow the SoC and prescribe basal before they prescribe meal time insulin, just the same as endos do. |
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Post by agedhippie on Aug 2, 2024 15:48:33 GMT -5
To the best of my knowledge Medicare will not cover CGMs for non-insulin users although some insurers will. Abbott are already presenting their finding showing the benefit of CGMs for GLP-1 users at international conferences. I remember you saying there is no way Medicare will ever cover CGMs for basal insulin using T2 just before Medicare approved exactly that. That was also all driven by trial data. We are talking T2s on Medicare for Abbott. That is their focus not the broader market for now. As I said before they had the studies ready to go with icodec buts thats DOA now. .... And as I said it's utterly irrelevant as the patients will all be on basal and thus covered for CGMs. Icodec failing to get approved doesn't change that one bit, the CGM makers still get the sales. |
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Post by sayhey24 on Aug 2, 2024 17:53:59 GMT -5
Most T2s don't go to endo's. The upside for the Abbotts is they need insulin prescribed to get the CGM sale. Afrezza fits nice with the PCP as there is little fear with hypos and no needles. Afrezza is just too damn expensive right now which insurance can fix. PCPs will follow the SoC and prescribe basal before they prescribe meal time insulin, just the same as endos do. So. Mike needs to get that changed. If Inhale-2 is as good as he has said he has the trial data. Abbott needs insulin prescribed earlier in the T2 life-cycle. Clearly not stage 4 as it is in the current SoC. They would like it as soon as diabetes is diagnosed but I am sure they will take stage 2. Remember what Ralph DeFronzo said - metformin is the biggest waste in T2 treatment. Prescribing basal before meal time as Al Mann use to say is just medically wrong. Your glucose is spiking at meals and thats when the spike needs to be stopped. The reason they did this was fear of hypos and the needle. Neither is a problem with afrezza. |
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Post by sayhey24 on Aug 2, 2024 17:56:59 GMT -5
We are talking T2s on Medicare for Abbott. That is their focus not the broader market for now. As I said before they had the studies ready to go with icodec buts thats DOA now. .... And as I said it's utterly irrelevant as the patients will all be on basal and thus covered for CGMs. Icodec failing to get approved doesn't change that one bit, the CGM makers still get the sales. 6 or 8 years later??? Are you kidding me. Robert Frost does not want to wait 6 or 8 years and then have these people die in 5 years from a heart attack. Get them the afrezza day 1 and get the CGM sales too. I am pretty sure getting them afrezza day 1 will also stop the progression and many will not have the cardo issues. |
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Post by prcgorman2 on Aug 2, 2024 21:06:00 GMT -5
That argument persuades me, and I don’t know why it isn’t more peruasive generally. I assume and believe poorly controlled or uncontrolled BG spikes cause harm, insidiously, slowly, over time.
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