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Post by audiomr on May 22, 2017 11:35:37 GMT -5
IMO take that study and throw it right in the trash. Metformin brings nothing good to anyone especially T2s. 70+% of T2 are not meeting goal. The goal is usually A1c of 7. Thats an average BG of 154 mg/dl. 140 is now considered the level when microvascular damage occurs. An A1c target of 7 in the "Age of afrezza" is a ridiculous target. IMO 5.5 would be much more realistic. Now I bet you almost 100% of the T2s are exceeding 140 after meals who are not using afrezza and maintaining that high level for hours and hours while their already impaired pancreas is working as hard as it can and burning out more beta cells in the process only to never catch-up before the next meal and never bringing the BG back below 100 let alone the 80-90 range it should be in. There is a session at ADA 2017. Hopefully both Dexcom and MNKD will have vocal representation there. The session is about should T2s be using CGMs. The answer is clearly NO if you are going to continue to treat them with metformin. Once Tim Cook and the rest of the general public see what their real numbers are anyone who cares about their health will take their metformin and throw that in the trash along with your study. My oh my, if you start letting these people see their numbers there are going to be riots. The last thing the ADA who has been recommending metformin for years as the first treatment for T2s wants is for the T2 to see their "time in range". There is no way they can let this happen but can they stop Tim Cook? And, Mango is 100% correct about the link between metformin and Alzheimer's. With metformin its a question of picking your poison. Do you want extended periods of high BG causing microvascluar damage so you can die of a heart attack or do you want to lose your mind. You can have both with metformin. Did you know that heart disease is the #1 cause of death. Do you know how many of them have diabetes? Could you imagine if the cause of death was listed on the certificate as diabetes/heart disease. I bet this would take over as #1. Note that the studies in question have nothing to do with diabetes. Effects in nondiabetics might be quite different from those in diabetics. Anyway, just what I consider an interesting aside. I don't see anyone being prescribed Metformin for life extension any time soon. |
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Post by Deleted on May 22, 2017 12:40:14 GMT -5
I'm in New York and routinely get prescriptions written by a Florida doc filled by mail order (OptumRx). Then maybe there isn't an issue because New York I thought was a problem state but evidently it isn't! NY is difficult to fill scripts in but I think more so for controlled substances than insulin. I have never bought insulin so I don't know for sure but I needed pain killers for my dog and it was such a headache. |
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Post by kball on May 22, 2017 12:56:00 GMT -5
Then maybe there isn't an issue because New York I thought was a problem state but evidently it isn't! NY is difficult to fill scripts in but I think more so for controlled substances than insulin. I have never bought insulin so I don't know for sure but I needed pain killers for my dog and it was such a headache.Your dog is a shareholder too? |
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Post by matt on May 22, 2017 13:02:35 GMT -5
NY is difficult to fill scripts in but I think more so for controlled substances than insulin. I have never bought insulin so I don't know for sure but I needed pain killers for my dog and it was such a headache.Your dog is a shareholder too? I nominate kball for the post of the year. |
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Post by agedhippie on May 22, 2017 13:11:07 GMT -5
IMO take that study and throw it right in the trash. Metformin brings nothing good to anyone especially T2s. 70+% of T2 are not meeting goal. The goal is usually A1c of 7. Thats an average BG of 154 mg/dl. 140 is now considered the level when microvascular damage occurs. Metformin works just fine for early stage Type 2s and it's not going to be displaced from that role any time soon. If people struggle to take one pill a day how do you think they are going to manage the suggested Afrezza regime with two tests and doses per meal? I will tell you know, it's not going to happen but don't let me stop any one dreaming, just don't confuse the dream with reality. Later in the cycle Afrezza has a role but realistically it is not competition for metformin at the point of monotherapy. |
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Post by BlueCat on May 22, 2017 13:24:13 GMT -5
Maybe Vdex will be one of the primary national teledocs that can review a patient's history online or via teleconferencing then forward the Afrezza prescription to Amazon for processing and delivery. You are going to run into the states Rx laws. I am not sure how a CA doctor writes an Rx to be filled in FL for example. I expect it's possible but I am not sure what is involved. Let's not forget that CA is a seriously large state and one of the largest economies in the world. There are a lot of folks across the state who can't just make a monthly RT drive or flight down to Socal. So for states that would not present any challenges (if there are any that do) and just opening up more across CA would significantly expand market reach and revenue opportunity. |
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Post by Deleted on May 22, 2017 13:43:22 GMT -5
NY is difficult to fill scripts in but I think more so for controlled substances than insulin. I have never bought insulin so I don't know for sure but I needed pain killers for my dog and it was such a headache.Your dog is a shareholder too? lol He was in the trenches with me so I guess that partially counts. |
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Post by boytroy88 on May 22, 2017 14:32:54 GMT -5
NY is difficult to fill scripts in but I think more so for controlled substances than insulin. I have never bought insulin so I don't know for sure but I needed pain killers for my dog and it was such a headache.Your dog is a shareholder too? I'm having lunch and almost sprayed my wife with the food in my mouth...lol...note to self...don't eat or drink while reading KC's posts.. |
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Post by bioexec25 on May 26, 2017 14:07:52 GMT -5
Come on Kball, jump back in and join us Longs. The long walk in the wilderness maybe coming to an end soon. Perhaps the slow craw across the Sahara a better analogy. ;-)). Regardless, always enjoy your posts.
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Post by dreamboatcruise on May 26, 2017 14:13:57 GMT -5
Come on Kball, jump back in and join us Longs. The long walk in the wilderness maybe coming to an end soon. Perhaps the slow craw across the Sahara a better analogy. ;-)). Regardless, always enjoy your posts. Our canteen is down to its last few sips of water... so logic would dictate we're either going to get out of the Sahara, or otherwise stop crawling, sometime soon.  |
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Post by zuegirdor on May 26, 2017 14:24:50 GMT -5
Come on Kball, jump back in and join us Longs. The long walk in the wilderness maybe coming to an end soon. Perhaps the slow craw across the Sahara a better analogy. ;-)). Regardless, always enjoy your posts. Our canteen is down to its last few sips of water... so logic would dictate we're either going to get out of the Sahara, or otherwise stop crawling, sometime soon. logic is a savage dicatator* *couldn't resist** **resistance is futile |
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Post by sla55 on May 26, 2017 15:34:25 GMT -5
On VDEX Diabetes Facebook page:
Vdex Diabetes
36 mins ·
What’s Wrong With Diabetes Care Today?
In a word, E v e r y t h I n g. We have more medications for treatment than ever before. We have better technology to apply to the management of the disease than ever before. We have more educational information/advice for sufferers than ever before. We have more funding for research than ever before. We have more professional industry organizations like the American Diabetes Association, the JDRF, the International Diabetes Federation than ever before, and…
We have more people suffering with diabetes than ever before.
How can this be? And what does it mean? Facts are stubborn things. It means we are really not making any impact on root causes such as obesity and inactivity. We may have more ways to treat the diseases (both Type 1 &
2), but we have more who need treatment. Even worse, recent research indicates that our level of control of the disease, as measured by HbA1c, is actually getting worse. We are doing a poorer job controlling blood sugar, though we have many more ways of doing so. Hard to believe? We’re doing more and getting less!
We’re actually going backwards in terms of our level of care.
Here’s some more sobering information. In 2001, projections from a leading industry publication estimated that, given the rapid growth rate of the disease, there would be 29 million diabetics in the US by 2050. In fact, we passed 30 million diabetics in 2015, 35 YEARS SOONER THAN PROJECTED!!! This disease is progressing faster than the experts predicted.
It appears the incidence of the disease is accelerating.
Clearly, it’s time for a different approach. Anyone who honestly looks at the treatment of this disease can come to no other conclusion. It hardly seems like we could do any worse than we’re doing now. And, consider the near miraculous advances we’ve made in the treatment of other diseases. HIV used to be fatal. It’s clearly not any more. There’s a cure for Hepatitis C now. Cancer survival rates are at all-time highs. Diabetes seems to run counter to the basic trend of advancement in medicine. So, what does this all mean?
It means…
with an unconventional situation, we should expect an unconventional solution.
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Post by dreamboatcruise on May 26, 2017 19:26:09 GMT -5
On VDEX Diabetes Facebook page: Vdex Diabetes 36 mins · What’s Wrong With Diabetes Care Today? In a word, E v e r y t h I n g. We have more medications for treatment than ever before. We have better technology to apply to the management of the disease than ever before. We have more educational information/advice for sufferers than ever before. We have more funding for research than ever before. We have more professional industry organizations like the American Diabetes Association, the JDRF, the International Diabetes Federation than ever before, and… We have more people suffering with diabetes than ever before. How can this be? And what does it mean? Facts are stubborn things. It means we are really not making any impact on root causes such as obesity and inactivity. We may have more ways to treat the diseases (both Type 1 & 2), but we have more who need treatment. Even worse, recent research indicates that our level of control of the disease, as measured by HbA1c, is actually getting worse. We are doing a poorer job controlling blood sugar, though we have many more ways of doing so. Hard to believe? We’re doing more and getting less!
We’re actually going backwards in terms of our level of care.Here’s some more sobering information. In 2001, projections from a leading industry publication estimated that, given the rapid growth rate of the disease, there would be 29 million diabetics in the US by 2050. In fact, we passed 30 million diabetics in 2015, 35 YEARS SOONER THAN PROJECTED!!! This disease is progressing faster than the experts predicted. It appears the incidence of the disease is accelerating. Clearly, it’s time for a different approach. Anyone who honestly looks at the treatment of this disease can come to no other conclusion. It hardly seems like we could do any worse than we’re doing now. And, consider the near miraculous advances we’ve made in the treatment of other diseases. HIV used to be fatal. It’s clearly not any more. There’s a cure for Hepatitis C now. Cancer survival rates are at all-time highs. Diabetes seems to run counter to the basic trend of advancement in medicine. So, what does this all mean? It means… with an unconventional situation, we should expect an unconventional solution. Yeah (bold)... perhaps someone should do a meta study to try to uncover if delaying insulin treatment with the new myriad of non-insulin solutions is leading to worse A1c when the people inevitability progress to having to go on insulin. They may be bandaids that seem to be working but allowing damage to the body to happen. |
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Post by agedhippie on May 26, 2017 21:56:18 GMT -5
A lot of the problem is simply getting people to take their diabetes seriously. Type 2 diabetes has little visible penalty for non-compliance until things start to go badly wrong and that can take a decade or so. You are getting people to change their lifestyle and that is always hard.
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Post by sayhey24 on May 27, 2017 2:39:48 GMT -5
A lot of the problem is simply getting people to take their diabetes seriously. Type 2 diabetes has little visible penalty for non-compliance until things start to go badly wrong and that can take a decade or so. You are getting people to change their lifestyle and that is always hard. You are exactly correct. However its more than just the T2s. Its also the medications they are given and who is giving them these pills? Once CGMs become standard for T2s there is no place to hide the numbers. The T2s will now know what is going on and the doctors can no longer hide behind the pills. T2s need to address their mealtime sugar spikes which in many cases can go 200+. Metformin nor baslin insulin nor lifestyle changes can address these spikes. The only thing which can is mealtime insulin. While low carb diets can help, afrezza pretty much obsoletes the need for things like the Bernstein diet. With afrezza they are better to have a well balanced lower fat diet. Exercise is great but again that is not going to address the 200+ mealtime spike. Only afrezza can provide the needed first phase insulin release to shut off the liver's glucose production which T2s lose and only insulin can lower high BG. As Dr. Bruce Bode said a few weeks back all T2s should be on afrezza within a year of two of diagnosis but I would say sooner. Metformin is a HUGE part of the problem in that it masks the problem by slowly bringing down the BG by reducing glucose production by the liver. This leaves the PWD in the 140+ range for extended periods as they incur micro-vascular damage and 70+% are not even meeting the 7 A1C. Its not only crazy but down right dangerous in the long term for the PWD. In short metformin maybe the worst thing a PWD can be given because it masks the problem, high mealtime sugar. In the end this just makes a big mess and if the PWD lives long enough they end up on insulin anyway. How many diabetics are dying from heart attacks? Who knows as its not currently tracked. Then again if you follow Dr Bodes advice afrezza obsoletes all current T2 medications and pretty much all use of basal insulin for T2s as they will never need it. This is about a $20B disruption to the current market so I would say Big Pharma will do all it can so that the T2s never ever see their numbers. While what Dexcom is doing will help, hopefully Tim Cook and Apple have other ideas so everyone sees their numbers and there is no longer a place to hide. Hopefully Dexcom comes with an army including Tim Cook, MNKD, Onduo and others to the ADA conference for the discussion on "Should T2s be given CGMs". The last thing the status quo wants is for T2s to know their numbers so unless they do we already know the answer, NO. What a mess it would make. |
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