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Post by uvula on Apr 8, 2016 13:34:52 GMT -5
Stevil said "But the AP likely wouldn't be the best option for those who were properly educated and motivated to take the best care of themselves. In other words, Afrezza would still be superior, but it'd come down to preference, convenience, and proper understanding of how to use each tool." (I messed up the quote formatting and can't fix it.) The data in the Ted talk video would suggest that this might not be true. It could be that glucagon and slow insulin give the same results as afrezza. Just because the AP will be easier and more convenient does not mean it will inferior to something (afrezza) that requires more effort. This would be great for T1Ds. As someone else mentioned here, there is still a need for afrezza in many T2Ds.
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Post by stevil on Apr 8, 2016 13:46:03 GMT -5
Stevil said "But the AP likely wouldn't be the best option for those who were properly educated and motivated to take the best care of themselves. In other words, Afrezza would still be superior, but it'd come down to preference, convenience, and proper understanding of how to use each tool." (I messed up the quote formatting and can't fix it.) The data in the Ted talk video would suggest that this might not be true. It could be that glucagon and slow insulin give the same results as afrezza. Just because the AP will be easier and more convenient does not mean it will inferior to something (afrezza) that requires more effort. This would be great for T1Ds. As someone else mentioned here, there is still a need for afrezza in many T2Ds.
I hadn't seen that post yet. I'll have to give it a listen sometime. I'm curious to hear how it'd be as good... I wonder if they're using incomplete data since the superiority studies haven't been completed. According to what we were taught in class (sorry on my phone and don't care to reference a source), the type 2 market was 4-5 times larger (and growing) so there will still be plenty of people in need of prandial insulin if they can compete with metformin
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Post by agedhippie on Apr 8, 2016 13:49:32 GMT -5
The highlighted section is key. I can live my life without having to think about glucose levels at all. No CGM alerts, no blood monitoring, no insulin bolus (inhaled or injected), no random spikes and drops, no worry about drinking (*cough*) or exercise, I can eat or snack when and what I want - just living. Why would I not want that? The reason I'm sticking with this stock for now is to give diabetics the choice to make the "right" decision. Convenience isn't the best option necessarily. It would be for those who don't place high importance on treating their bodies the best way possible. There is likely a large percentage of diabetics who want to not take their healthcare in their own hands. I think anybody with a chronic disease would be guilty of that- not trying to stereotype diabetics in that respect. But the AP likely wouldn't be the best option for those who were properly educated and motivated to take the best care of themselves. In other words, Afrezza would still be superior, but it'd come down to preference, convenience, and proper understanding of how to use each tool. Trust me - there will be a stampede when the AP comes out. The motivated and educated will be at the front of the queue. Let me forget I have diabetes? Where do I sign! Some people will not want an AP because they don't trust it (loss of control), or they dislike being tethered to something, or they do well enough on what they have not to want to change. I probably spend as much time off a pump as on one because if I have to bolus anyway any injection is no worse than typing instructions to the pump - an AP would change that for me in both cases. We are talking about a relatively small population here anyway, Type 2 is where the bulk of the market is and they will never get APs or CGMs. They will get Afrezza though.
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Post by uvula on Apr 8, 2016 13:59:18 GMT -5
Just to make it easier to find, this is the ted talk I was referring to: www.betabionics.org/#!tedx/dnkxq
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Post by agedhippie on Apr 8, 2016 14:48:37 GMT -5
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Post by sweedee79 on Apr 8, 2016 20:47:50 GMT -5
I have only talked to 3 diabetics, but their faces light up whenever they talk about it, but that's probably because they're already educated on the AP. I just think that Afrezza might require too much education for diabetics to really get excited about. I'm not sure they understand the science behind it all too well... Education isn't the problem - the problem is that I still have to carry around stuff and use it whenever I eat anything. I want to forget I have diabetes. That is the promise of the AP and why those diabetics eyes light up when they talk about it. It's very hard to convey exactly how big a deal this is for a Type 1 and is why organizations like the Lilly, JDRF and NIH are funding clinical trials for these devices. mentioned an AP to my dad tonight.. he isn't interested .. he is type 1 as stated earlier..
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Post by Deleted on Apr 12, 2016 7:43:16 GMT -5
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Post by lakon on Apr 12, 2016 15:02:57 GMT -5
I don't mean to be insensitive or burst anyone's bubble, but I am going to make two predictions here.
(1) There will NOT be any significant global market penetration of any AP in ten years, maybe twenty, probably ever.
(2) Ongoing research of auto-immune diseases, stem cells, bio-printing, cloning, and growing human organs in animal models will make any AP obsolete as it will eventually cure the disease.
Mann thought AP probably should not be tried because it's not the most economically viable option. Results should be as good with Afrezza and far simpler technology, thus lower risk and more business sense. DeSisto talked about always playing catch-up to what you don't know (the future -- what a diabetic will DO NEXT -- eat/drink/run-a-marathon). That makes the problem/solution dependent on more input information. No matter what, patients will not be free from thinking about their disease.
The way to do that is to fix the underlying problem(s) [2].
An AP is just another variant of the same old therapeutics with a few new tricks that may or may not produce superior outcomes. With Afrezza and possible future Technosphere applications, it should be possible for patients to dose themselves appropriately when needed instead of telling a computer enough information to augment its diagnostics to get it right. Barring that, the computer has to do a lot of back and forth corrections, and what does that do to a diabetic's body? Research and trials needed there for long-term effects. We do need much better sensors for much better diagnostics, and I hope that we get heavy investment in improving diagnostics with non-invasive near real-time technologies. I do hope that some of these early AP's are successful at helping early adopters, but I think ultimately the businesses will fail.
The good news is that I think we have a good shot at a cure within another decade, but it too may take a while to distribute. Tresiba/Afrezza and other insulin will keep diabetics going around the world until a cure reaches them.
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Post by rockstarrick on Apr 12, 2016 18:13:48 GMT -5
I don't mean to be insensitive or burst anyone's bubble, but I am going to make two predictions here. (1) There will NOT be any significant global market penetration of any AP in ten years, maybe twenty, probably ever. (2) Ongoing research of auto-immune diseases, stem cells, bio-printing, cloning, and growing human organs in animal models will make any AP obsolete as it will eventually cure the disease. Mann thought AP probably should not be tried because it's not the most economically viable option. Results should be as good with Afrezza and far simpler technology, thus lower risk and more business sense. DeSisto talked about always playing catch-up to what you don't know (the future -- what a diabetic will DO NEXT -- eat/drink/run-a-marathon). That makes the problem/solution dependent on more input information. No matter what, patients will not be free from thinking about their disease. The way to do that is to fix the underlying problem(s) [2]. An AP is just another variant of the same old therapeutics with a few new tricks that may or may not produce superior outcomes. With Afrezza and possible future Technosphere applications, it should be possible for patients to dose themselves appropriately when needed instead of telling a computer enough information to augment its diagnostics to get it right. Barring that, the computer has to do a lot of back and forth corrections, and what does that do to a diabetic's body? Research and trials needed there for long-term effects. We do need much better sensors for much better diagnostics, and I hope that we get heavy investment in improving diagnostics with non-invasive near real-time technologies. I do hope that some of these early AP's are successful at helping early adopters, but I think ultimately the businesses will fail. The good news is that I think we have a good shot at a cure within another decade, but it too may take a while to distribute. Tresiba/Afrezza and other insulin will keep diabetics going around the world until a cure reaches them. I agree 100%, an APS is just not practical in any way, IMO. I can tell you from personal experience, trying to write a logic program for an automated closed loop system of any kind is very frustrating. Anytime you have a pump that is controlled by send/receive data, (4:20 closed loop for example), to reach a certain set point or "goal", the pump overshoots and undershoots the goal for quite a period of time before stabilizing. Then once it does stabilize, or flatline, it will only last until the data, or in this case, glucose changes, due to a meal or snack. Pumps can't stop on a dime, you would never get the tight control, or time in zone, that Afrezza users are experiencing. Nearly impossible IMO Afrezza is here to stay, and will be by far, the most significant advancement in Diabetes for many years.
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Post by agedhippie on Apr 12, 2016 19:04:07 GMT -5
I don't mean to be insensitive or burst anyone's bubble, but I am going to make two predictions here. (1) There will NOT be any significant global market penetration of any AP in ten years, maybe twenty, probably ever. (2) Ongoing research of auto-immune diseases, stem cells, bio-printing, cloning, and growing human organs in animal models will make any AP obsolete as it will eventually cure the disease. (1) The global market isn't really relevant - look at Dexcom with 150,000 users globally. Now look at the potential in North America and Western Europe. In the US they will cover it because the cost will be comparable with a pump + CGM, in Europe they will cover it because it is a single payer system so lifetime costs matter. (2) A cure is always five years away, it a diabetic law. While this sounds nice in principle it will never work because no matter how you make beta cells your immune system can kill then faster. You see Type 1 diabetics still produce beta cells but their immune systems kill them as fast as they are made. The AP will be here within two years - you can take that to the bank. Medtronix have already said that their next pump will be an AP, Tandem and iLet are about to go to trials. And if Medtronix next pump will be an AP you can be certain that JNJ will do the same with Animas. Roche are developing a CGM specifically for their own AP. In theory Insulet (Omnipod) are as well but I have my doubts as I think they are under-resourced. You miss the point. What is wanted isn't a treatment that gives me the lowest possible A1c - it just needs to be good enough. Its a treatment that means I don't need to do anything beyond periodically swapping out my sites. An A1c below 6.5 is good enough to ensure that my chances of complications are minimal so I don't need to get to 5.7 as it's overkill. The businesses are unlikely to fail. Look at JNJ with Animas and Medtronics with their AP projects. The technology is there today which is why the big trials are starting this year You obviously haven't been in the diabetic world long enough - there is always a cure coming! Really we have no shot at a cure, and Type 2 diabetics have even less chance.
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Post by sweedee79 on Apr 12, 2016 19:15:06 GMT -5
I don't mean to be insensitive or burst anyone's bubble, but I am going to make two predictions here. (1) There will NOT be any significant global market penetration of any AP in ten years, maybe twenty, probably ever. (2) Ongoing research of auto-immune diseases, stem cells, bio-printing, cloning, and growing human organs in animal models will make any AP obsolete as it will eventually cure the disease. Mann thought AP probably should not be tried because it's not the most economically viable option. Results should be as good with Afrezza and far simpler technology, thus lower risk and more business sense. DeSisto talked about always playing catch-up to what you don't know (the future -- what a diabetic will DO NEXT -- eat/drink/run-a-marathon). That makes the problem/solution dependent on more input information. No matter what, patients will not be free from thinking about their disease. The way to do that is to fix the underlying problem(s) [2]. An AP is just another variant of the same old therapeutics with a few new tricks that may or may not produce superior outcomes. With Afrezza and possible future Technosphere applications, it should be possible for patients to dose themselves appropriately when needed instead of telling a computer enough information to augment its diagnostics to get it right. Barring that, the computer has to do a lot of back and forth corrections, and what does that do to a diabetic's body? Research and trials needed there for long-term effects. We do need much better sensors for much better diagnostics, and I hope that we get heavy investment in improving diagnostics with non-invasive near real-time technologies. I do hope that some of these early AP's are successful at helping early adopters, but I think ultimately the businesses will fail. The good news is that I think we have a good shot at a cure within another decade, but it too may take a while to distribute. Tresiba/Afrezza and other insulin will keep diabetics going around the world until a cure reaches them. thanks for this post and information.. You seem very knowledgeable about it .. and I agree .. The one thing that sticks out to me is the use of the same old insulin.. the kind that hangs in your body and causes weight gain.. and according to my dad, lethargy..
If it were me I would want Afrezza hands down.. because its quick and mimics the pancreas.. and its not that hard to use.. also if the doc who prescribes it understands Afrezza it is possible that you can eat more of what you want ... and lead a normal life.
I would rather be in control of my own disease, on a superior insulin than depend on a machine that uses a hexamer and is also pumping glucose in to regulate my blood sugar.. I don't know, I just don't like it.. (not that I'm biased or anything
A possible cure in 10 years??? That is amazing.... for all the people suffering with this disease I surely hope that happens.. no one really knows what its like until you've been through it.. diabetes causes a lot of hardship.... including depression.. I know my dad feels very alone sometimes with his disease because others don't understand what he goes through..
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Post by agedhippie on Apr 12, 2016 19:26:44 GMT -5
I agree 100%, an APS is just not practical in any way, IMO. I can tell you from personal experience, trying to write a logic program for an automated closed loop system of any kind is very frustrating. Anytime you have a pump that is controlled by send/receive data, (4:20 closed loop for example), to reach a certain set point or "goal", the pump overshoots and undershoots the goal for quite a period of time before stabilizing. Then once it does stabilize, or flatline, it will only last until the data, or in this case, glucose changes, due to a meal or snack. Pumps can't stop on a dime, you would never get the tight control, or time in zone, that Afrezza users are experiencing. Nearly impossible IMO Afrezza is here to stay, and will be by far, the most significant advancement in Diabetes for many years. What can I say? This work has already been done and it's the basis of how CGMs work. A CGM measures glucose in interstitial fluids which lag your blood glucose by around 20 minutes. What you see when you look at a CGM is where your CGM thinks you are now based on where you were 20 minutes ago. There are some smart algorithms in those to the point where in theory you can dose of a Dexcom with their 505 software release. Today pumps like the Animas Vibe and the Medtronix 640G will decide you are going low and back off the insulin to stop that happening without any human intervention. As for the AP look at that TED talk and the graph for the diabetics - solidly in range while it was all over the place before. Medtronics are currently running a trial to prove superiority for their 670G hybrid system. Dr Bode is running one of the sites at Atlanta Diabetes Associates so obviously he thinks it is worthwhile. As I said before none of this detracts from Afrezza because the Type 2 market will always be there and its 80% of the diabetics.
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Post by rockstarrick on Apr 12, 2016 19:57:03 GMT -5
I agree 100%, an APS is just not practical in any way, IMO. I can tell you from personal experience, trying to write a logic program for an automated closed loop system of any kind is very frustrating. Anytime you have a pump that is controlled by send/receive data, (4:20 closed loop for example), to reach a certain set point or "goal", the pump overshoots and undershoots the goal for quite a period of time before stabilizing. Then once it does stabilize, or flatline, it will only last until the data, or in this case, glucose changes, due to a meal or snack. Pumps can't stop on a dime, you would never get the tight control, or time in zone, that Afrezza users are experiencing. Nearly impossible IMO Afrezza is here to stay, and will be by far, the most significant advancement in Diabetes for many years. What can I say? This work has already been done and it's the basis of how CGMs work. A CGM measures glucose in interstitial fluids which lag your blood glucose by around 20 minutes. What you see when you look at a CGM is where your CGM thinks you are now based on where you were 20 minutes ago. There are some smart algorithms in those to the point where in theory you can dose of a Dexcom with their 505 software release. Today pumps like the Animas Vibe and the Medtronix 640G will decide you are going low and back off the insulin to stop that happening without any human intervention. As for the AP look at that TED talk and the graph for the diabetics - solidly in range while it was all over the place before. Medtronics are currently running a trial to prove superiority for their 670G hybrid system. Dr Bode is running one of the sites at Atlanta Diabetes Associates so obviously he thinks it is worthwhile. As I said before none of this detracts from Afrezza because the Type 2 market will always be there and its 80% of the diabetics. The CGM is the analyzer, not the pump, the distance between that analyzer and the actual pump is what causes the delay. The longer the distance, the longer the delay. Can you share a link about the system you are talking about, (I'm not doubting you, you are one of my favorite members !!). I have never worked with medical chemical pumps, I would like to read the article. Thanks
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Post by uvula on Apr 12, 2016 20:46:34 GMT -5
Rockstar, you have been going on and on about how APs can never work and you don't even know anything about them? Watch the TEDx video in this website. www.betabionics.org It shows some very impressive graphs at the 12 minute mark. I am not an expert either but I think the "trick" is that the fast acting glucagon makes up for the use of slow acting insulin. This may or may not be the best AP but it is representative of technology that exists today even if it is not an approved product yet.
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Post by rockstarrick on Apr 12, 2016 23:02:31 GMT -5
Rockstar, you have been going on and on about how APs can never work and you don't even know anything about them? Watch the TEDx video in this website. www.betabionics.org It shows some very impressive graphs at the 12 minute mark. I am not an expert either but I think the "trick" is that the fast acting glucagon makes up for the use of slow acting insulin. This may or may not be the best AP but it is representative of technology that exists today even if it is not an approved product yet. Nice presentation, I was curious about the actual numbers in the trends, there were none, but that was a great looking improvement from before the AB and after. I didn't mean to ramble, or go "on and on", all I was doing was agreeing with an opinion, (lakons) and using my own experience with closed loop system chemical pumps to explain why I agreed. And I believe you are correct about the glucagon, it is probably used to soften the landings, it's hard to figure out how they are avoiding the highs though. so when will this Technology be available ?? Thank you for sharing the link, I enjoyed watching it.
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