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Post by akemp3000 on Jul 30, 2016 17:00:23 GMT -5
Using A1c numbers or even B/G numbers when comparing prandial drugs head-to-head is now antiquated. The results coming in when prandial drugs are combined with CGMs and Afrezza are showing never before seen improvement and results. A single prandial drug may appear to deliver better results than a competitor's drug when compared head-to-head but when used with CGMs and Afrezza, the results can change. It's starting to look like the use of Tresiba, Afrezza and a CGM (the TAC team) are delivering the best results ever seen by diabetics. See Sam Finta a/k/a Afrezzauser. Comparable results do not appear to be coming in when using other prandial drugs in this combination. This is new so future results need to be shared and discussed. If true, this may be the start of a true paradigm shift in diabetes treatment.
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Post by agedhippie on Jul 30, 2016 17:20:38 GMT -5
Using A1c numbers or even B/G numbers when comparing prandial drugs head-to-head is now antiquated. The results coming in when prandial drugs are combined with CGMs and Afrezza are showing never before seen improvement and results. A single prandial drug may appear to deliver better results than a competitor's drug when compared head-to-head but when used with CGMs and Afrezza, the results can change. It's starting to look like the use of Tresiba, Afrezza and a CGM (the TAC team) are delivering the best results ever seen by diabetics. See Sam Finta a/k/a Afrezzauser. Comparable results do not appear to be coming in when using other prandial drugs in this combination. This is new so future results need to be shared and discussed. If true, this may be the start of a true paradigm shift in diabetes treatment. Nice idea, but it's not going to happen. This is a world where a Type 2 not on insulin is limited to about one test strip a day and the debate is whether that is to much, European health systems are moving Type 2s off Lantus and onto NPH, and every one is paranoid about cost. A CGM is painfully expensive to self-fund (over $6,000 per year), non-trivial to get on insurance even as a Type 1, and impossible under any circumstances on Medicare. Cost, cost, cost, without hard trial data showing really significant improvement it all stands or falls on cost. Sorry - bit of a rant there but its a sore spot. |
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Post by akemp3000 on Jul 30, 2016 22:02:04 GMT -5
It's a valid point based on the world as it exists today but this is the very reason a paradigm shift will occur. The cost of the prandial drug, CGM, etc. is minor compared to the cost of living a normal life with little concern over hypoglycemia, amputations, hospitalizations, etc. The proof is in the results and until something else comes along, the best results currently belong to Tresiba, Afrezza and CGMs.
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Post by agedhippie on Jul 31, 2016 8:53:49 GMT -5
It's a valid point based on the world as it exists today but this is the very reason a paradigm shift will occur. The cost of the prandial drug, CGM, etc. is minor compared to the cost of living a normal life with little concern over hypoglycemia, amputations, hospitalizations, etc. The proof is in the results and until something else comes along, the best results currently belong to Tresiba, Afrezza and CGMs. Sadly the answer is that the paradigm will not shift and I say that as someone who campaigns for better diabetes care (self-interest here). Your problem is that the cost of that combination is far from minor and quite simply nobody could afford to implement it at scale. There is a reason health systems are moving Type 2 diabetics off Lantus and onto NPH and it is cost because it certainly isn't convenience or performance. Given that they are hardly likely to move them to Tresiba which is even more expensive than Lantus. It sucks, but diabetes can easily swap an entire national budget if you use the best treatment so it isn't going to happen. |
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Post by audiomr on Jul 31, 2016 11:45:01 GMT -5
Using A1c numbers or even B/G numbers when comparing prandial drugs head-to-head is now antiquated. The results coming in when prandial drugs are combined with CGMs and Afrezza are showing never before seen improvement and results. A single prandial drug may appear to deliver better results than a competitor's drug when compared head-to-head but when used with CGMs and Afrezza, the results can change. It's starting to look like the use of Tresiba, Afrezza and a CGM (the TAC team) are delivering the best results ever seen by diabetics. See Sam Finta a/k/a Afrezzauser. Comparable results do not appear to be coming in when using other prandial drugs in this combination. This is new so future results need to be shared and discussed. If true, this may be the start of a true paradigm shift in diabetes treatment. What are you referring to as prandial drugs? Afrezza is a prandial med, so it would not be combined with another. |
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Post by mnholdem on Jul 31, 2016 13:25:41 GMT -5
Using A1c numbers or even B/G numbers when comparing prandial drugs head-to-head is now antiquated. The results coming in when prandial drugs are combined with CGMs and Afrezza are showing never before seen improvement and results. A single prandial drug may appear to deliver better results than a competitor's drug when compared head-to-head but when used with CGMs and Afrezza, the results can change. It's starting to look like the use of Tresiba, Afrezza and a CGM (the TAC team) are delivering the best results ever seen by diabetics. See Sam Finta a/k/a Afrezzauser. Comparable results do not appear to be coming in when using other prandial drugs in this combination. This is new so future results need to be shared and discussed. If true, this may be the start of a true paradigm shift in diabetes treatment. What are you referring to as prandial drugs? Afrezza is a prandial med, so it would not be combined with another. I interpreted akemp3000 to mean other prandials in combination with Tresiba are not being reported to be performing as well as Afrezza with Tresiba. I don't think Novo-Nordisk is happy about it and I don't expect they will publicly advocate how well Afrezza works when combined with their basal Tresiba. After all, Afrezza directly competes with Novo's prandial RAA insulin Novolog.  |
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Post by akemp3000 on Jul 31, 2016 15:07:16 GMT -5
Exactly! Afrezza can be compared to other prandial solutions just like basal solutions can be compared with one another. The point is that this type of head-to-head comparison should now be considered antiquated or inadequate now that it "appears" the combination of Tresiba, Afrezza and a cgm might just offer the best "package" solution that diabetics have seen to date. Future comparisons should include the combination basal and prandial package proposed with "time-in-range" results from cgms.
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Post by agedhippie on Jul 31, 2016 16:21:13 GMT -5
Exactly! Afrezza can be compared to other prandial solutions just like basal solutions can be compared with one another. The point is that this type of head-to-head comparison should now be considered antiquated or inadequate now that it "appears" the combination of Tresiba, Afrezza and a cgm might just offer the best "package" solution that diabetics have seen to date. Future comparisons should include the combination basal and prandial package proposed with "time-in-range" results from cgms. Both basal and prandial insulin operate entirely independently of each other. Tresiba will behave as a basal exactly the same with Humalog as it will with Afrezza. The combination is not magic, its apparently just a good combination for some people (not for mikep though!) Because these are independent they will never do what you suggest in trials or studies. |
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Post by Deleted on Jul 31, 2016 16:37:57 GMT -5
Exactly! Afrezza can be compared to other prandial solutions just like basal solutions can be compared with one another. The point is that this type of head-to-head comparison should now be considered antiquated or inadequate now that it "appears" the combination of Tresiba, Afrezza and a cgm might just offer the best "package" solution that diabetics have seen to date. Future comparisons should include the combination basal and prandial package proposed with "time-in-range" results from cgms. Both basal and prandial insulin operate entirely independently of each other. Tresiba will behave as a basal exactly the same with Humalog as it will with Afrezza. The combination is not magic, its apparently just a good combination for some people (not for mikep though!) Because these are independent they will never do what you suggest in trials or studies. mikep still uses Afrezza not 100% though |
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Post by peppy on Jul 31, 2016 16:42:48 GMT -5
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Post by agedhippie on Jul 31, 2016 16:59:14 GMT -5
Both basal and prandial insulin operate entirely independently of each other. Tresiba will behave as a basal exactly the same with Humalog as it will with Afrezza. The combination is not magic, its apparently just a good combination for some people (not for mikep though!) Because these are independent they will never do what you suggest in trials or studies. mikep still uses Afrezza not 100% though My fault, I wasn't clear. It was meant as a reference to Tresiba which he has stopped using. |
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Post by mnkdnut on Jul 31, 2016 18:18:24 GMT -5
It's a valid point based on the world as it exists today but this is the very reason a paradigm shift will occur. The cost of the prandial drug, CGM, etc. is minor compared to the cost of living a normal life with little concern over hypoglycemia, amputations, hospitalizations, etc. The proof is in the results and until something else comes along, the best results currently belong to Tresiba, Afrezza and CGMs.You may be absolutely correct, akemp, and most on this board are betting on it. However, the scientific proof on Afrezza superiority is missing (anecdotal "proof" - ok, we got lots of that). Those that hang their careers on making decisions regarding pharmaceuticals (eg. payers and prescribers) need controlled clinical studies to back up claims of actual superior outcomes. They can't afford to chase after every new shiny invention that "might" be better. The PK/PD profile data has been around since FDA approval and is a teaser of interesting potential, not a substitute for actual outcomes. For whatever reasons, MNKD's scientific and clinical staff has yet to be able to deliver scientific/clinical proof of superiority (an epic fail in my opinion. Was Al too lenient with his staff?), so the sales team must fight with one arm tied behind their backs. Sanofi should have known to address this early on, but of course we know now it was game over as soon as Brandicourt entered. I have high hopes for the pediatric study- even though it likely won't address adults as far as FDA is concerned - but we're counting on Mike C and RLS to keep the doors open until then. Heck, I'd be thrilled to see even a time-in-range study at this point. The pharmaceutical industry competes on clinical data that supports cost/benefit analyses. We can't keep hoping to win through compelling individual case histories, no matter how emotionally uplifting they are. |
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Post by akemp3000 on Jul 31, 2016 18:23:30 GMT -5
Exactly! Afrezza can be compared to other prandial solutions just like basal solutions can be compared with one another. The point is that this type of head-to-head comparison should now be considered antiquated or inadequate now that it "appears" the combination of Tresiba, Afrezza and a cgm might just offer the best "package" solution that diabetics have seen to date. Future comparisons should include the combination basal and prandial package proposed with "time-in-range" results from cgms. Both basal and prandial insulin operate entirely independently of each other. Tresiba will behave as a basal exactly the same with Humalog as it will with Afrezza. The combination is not magic, its apparently just a good combination for some people (not for mikep though!) Because these are independent they will never do what you suggest in trials or studies. Someone posted a technical chemical explanation of why basal and prandial insulins do not always operate entirely independent of each other. The post specifically referenced Toujeo's chemistry and how it reduced the effectiveness when combined with Afrezza whereas Tresiba did not. Maybe someone can re-post. |
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Post by agedhippie on Jul 31, 2016 19:10:30 GMT -5
Both basal and prandial insulin operate entirely independently of each other. Tresiba will behave as a basal exactly the same with Humalog as it will with Afrezza. The combination is not magic, its apparently just a good combination for some people (not for mikep though!) Because these are independent they will never do what you suggest in trials or studies. Someone posted a technical chemical explanation of why basal and prandial insulins do not always operate entirely independent of each other. The post specifically referenced Toujeo's chemistry and how it reduced the effectiveness when combined with Afrezza whereas Tresiba did not. Maybe someone can re-post. I would be really interested to see that because it's the first I have heard of it. The only way it is a problem is if you physically mix the two in the same syringe. Mixing them causes precipitate to form and the peak activity of the prandial insulin gets delayed - early GIR drops, late GIR rises. For obvious reasons that's difficult to physically mix any insulin with Afrezza  |
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Post by peppy on Jul 31, 2016 20:08:20 GMT -5
It's a valid point based on the world as it exists today but this is the very reason a paradigm shift will occur. The cost of the prandial drug, CGM, etc. is minor compared to the cost of living a normal life with little concern over hypoglycemia, amputations, hospitalizations, etc. The proof is in the results and until something else comes along, the best results currently belong to Tresiba, Afrezza and CGMs.You may be absolutely correct, akemp, and most on this board are betting on it. However, the scientific proof on Afrezza superiority is missing (anecdotal "proof" - ok, we got lots of that). Those that hang their careers on making decisions regarding pharmaceuticals (eg. payers and prescribers) need controlled clinical studies to back up claims of actual superior outcomes. They can't afford to chase after every new shiny invention that "might" be better. The PK/PD profile data has been around since FDA approval and is a teaser of interesting potential, not a substitute for actual outcomes. For whatever reasons, MNKD's scientific and clinical staff has yet to be able to deliver scientific/clinical proof of superiority (an epic fail in my opinion. Was Al too lenient with his staff?), so the sales team must fight with one arm tied behind their backs. Sanofi should have known to address this early on, but of course we know now it was game over as soon as Brandicourt entered. I have high hopes for the pediatric study- even though it likely won't address adults as far as FDA is concerned - but we're counting on Mike C and RLS to keep the doors open until then. Heck, I'd be thrilled to see even a time-in-range study at this point. The pharmaceutical industry competes on clinical data that supports cost/benefit analyses. We can't keep hoping to win through compelling individual case histories, no matter how emotionally uplifting they are. Same old chit, different day. The reason your story does not work is we are not blind, we can see. screencast.com/t/s6neMncEshf screencast.com/t/4W2uaL19IqtW screencast.com/t/o52jfDnnZa screencast.com/t/z2NNkTxeg screencast.com/t/1lw4RXiEpU screencast.com/t/Ab2vH63GqdV screencast.com/t/buvxOYfOb screencast.com/t/A4BkzUlvr9 screencast.com/t/rU8FNwJ8o1E screencast.com/t/9M4hRMCZpp screencast.com/t/fxfLxL0g screencast.com/t/WRntikEkOpV
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