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Post by MnkdWASmyRtrmntPlan on Oct 25, 2017 12:55:06 GMT -5
Sorry for being a downer today, but I heard a radio show this morning on a local NPR station broadcast live from the Cleveland Clinic Medical Innovation Summit 2017 which provides a glimpse of big changes in the upcoming year for the Health Care industry - like the TED of healthcare. Dr. Michael Roizen, the Cleveland Clinic's Chief Wellness officer and author (or, coauthor) of five number 1 NY Times Bestseller books (including the “You” series, starting with "You: The Owner's Manual") presented the best upcoming innovations to change the state of health care for 2018. The top product that he reviewed was a Hybrid Closed-loop insulin delivery system that was referred to as an artificial pancreas for T1 diabetics (and can be used for T2's after more testing). It includes a remote monitoring service. I didn't hear him give specifics on the name or manufacturing company, and today’s radio article is not posted on the radio station's website yet, but I believe this hotlink reviews the system he referred to: www.seas.harvard.edu/news/2017/10/artificial-pancreas-performs-well-in-clinical-trialIf this were used with Fiasp and marketed by the big pharma beneficiaries of this system, it would be big competition for Afrezza, despite Fiasp’s inferiority. I invite everyone to shoot holes in this. |
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Post by itellthefuture777 on Oct 25, 2017 13:22:06 GMT -5
FIASP is to slow in..and Out..it is what it is..a fat slow drug with side effects...If they are used in the artificial pancreas..then also so would be Afrezza..with..better outcomes..FIASP..if it were Mannkinds only drug..would put Mannkind out of business...if NOVO had Afrezza...so..
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Post by dreamboatcruise on Oct 25, 2017 13:25:09 GMT -5
Sorry for being a downer today, but I heard a radio show this morning on a local NPR station broadcast live from the Cleveland Clinic Medical Innovation Summit 2017 which provides a glimpse of big changes in the upcoming year for the Health Care industry - like the TED of healthcare. Dr. Michael Roizen, the Cleveland Clinic's Chief Wellness officer and author (or, coauthor) of five number 1 NY Times Bestseller books (including the “You” series, starting with "You: The Owner's Manual") presented the best upcoming innovations to change the state of health care for 2018. The top product that he reviewed was a Hybrid Closed-loop insulin delivery system that was referred to as an artificial pancreas for T1 diabetics (and can be used for T2's after more testing). It includes a remote monitoring service. I didn't hear him give specifics on the name or manufacturing company, and today’s radio article is not posted on the radio station's website yet, but I believe this hotlink reviews the system he referred to: www.seas.harvard.edu/news/2017/10/artificial-pancreas-performs-well-in-clinical-trialIf this were used with Fiasp and marketed by the big pharma beneficiaries of this system, it would be big competition for Afrezza, despite Fiasp’s inferiority. I invite everyone to shoot holes in this. The link seems to show a closed-loop rather than hybrid closed-loop. Hybrid implies some insulin dosing is being done manually rather than with pump (at least I think that is the common usage of that term). Afrezza could be used with hybrid closed loop AP, and likely with some benefit... but offset by the fact that if there is already a pump with RAA (or Fiasp... though the injection site issues of Fiasp might be exacerbated with a pump), would the benefit outweigh the downside of adding manual dosing to what could otherwise be fully automated. Setting that aside, however, I'd argue that one could probably get as good results (possibly better) using Tresiba and Afrezza. Yes, it is not automated, but an AP system adds a heck of a lot of extra cost for payers and involves two invasive devices hanging off one's body 24/7. I won't claim to know with any certainty what fraction of patients would prefer an AP system to a combo like Tresiba and Afrezza, but I am certainly comfortable with my bet on Afrezza (at least with regard to this potential AP threat). Add in non-invasive BG meters (hopefully within next 24 months) and I think the case for Tresiba+Afrezza over pump looks even more attractive. I'm pretty certain I'd prefer Tresiba+Afrezza vs AP if I'm ever faced with that choice. Dual hormone APs (insulin + glucagon) would likely be the most serious challenge to Afrezza. |
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Post by babaoriley on Oct 25, 2017 14:08:37 GMT -5
We only need a sliver of the market to boost our market cap appreciably. Currently, we're not even a niche of a niche, maybe a son of a niche, at best.
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Post by rockstarrick on Oct 25, 2017 14:12:02 GMT -5
Sorry for being a downer today, but I heard a radio show this morning on a local NPR station broadcast live from the Cleveland Clinic Medical Innovation Summit 2017 which provides a glimpse of big changes in the upcoming year for the Health Care industry - like the TED of healthcare. Dr. Michael Roizen, the Cleveland Clinic's Chief Wellness officer and author (or, coauthor) of five number 1 NY Times Bestseller books (including the “You” series, starting with "You: The Owner's Manual") presented the best upcoming innovations to change the state of health care for 2018. The top product that he reviewed was a Hybrid Closed-loop insulin delivery system that was referred to as an artificial pancreas for T1 diabetics (and can be used for T2's after more testing). It includes a remote monitoring service. I didn't hear him give specifics on the name or manufacturing company, and today’s radio article is not posted on the radio station's website yet, but I believe this hotlink reviews the system he referred to: www.seas.harvard.edu/news/2017/10/artificial-pancreas-performs-well-in-clinical-trialIf this were used with Fiasp and marketed by the big pharma beneficiaries of this system, it would be big competition for Afrezza, despite Fiasp’s inferiority. I invite everyone to shoot holes in this. The link seems to show a closed-loop rather than hybrid closed-loop. Hybrid implies some insulin dosing is being done manually rather than with pump (at least I think that is the common usage of that term). Afrezza could be used with hybrid closed loop AP, and likely with some benefit... but offset by the fact that if there is already a pump with RAA (or Fiasp... though the injection site issues of Fiasp might be exacerbated with a pump), would the benefit outweigh the downside of adding manual dosing to what could otherwise be fully automated. Setting that aside, however, I'd argue that one could probably get as good results (possibly better) using Tresiba and Afrezza. Yes, it is not automated, but an AP system adds a heck of a lot of extra cost for payers and involves two invasive devices hanging off one's body 24/7. I won't claim to know with any certainty what fraction of patients would prefer an AP system to a combo like Tresiba and Afrezza, but I am certainly comfortable with my bet on Afrezza (at least with regard to this potential AP threat). Add in non-invasive BG meters (hopefully within next 24 months) and I think the case for Tresiba+Afrezza over pump looks even more attractive. I'm pretty certain I'd prefer Tresiba+Afrezza vs AP if I'm ever faced with that choice. Dual hormone APs (insulin + glucagon) would likely be the most serious challenge to Afrezza. Closed loops are absolute nightmares if not calibrated frequently and accurately. It’s nearly impossible to get a pump to change directions without overshooting the desired set point resulting in higher and lower doses of whatever it is you are feeding, until the pump stabilizes. I can imagine when dosing something like Insulin, these fluctuations would happen after every meal !! I can’t see them getting it done without paying special attention to fluctuating mealtime glucose levels, which in my opinion, takes a lot of the automation out of it. I agree 100%, they will get better glucose levels easier with Tresiba and Afrezza. This will only be an issue until more PWD learn of the Tresiba/Afrezza combination. 👀 |
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Post by dreamboatcruise on Oct 25, 2017 14:49:05 GMT -5
rockstarrick... there is variability in absorption dynamics (such as caused by hydration level), so it really isn't even possible to just have a calibrated electro-mechanical pump system. An AP really has to adjust for end to end dynamics using the CGM. Dual hormone helps with the issue of overshooting. I haven't really tracked the research in APs to see what level of time in range they are achieving, as my basic thesis on Afrezza is that even if an AP can match the results, the cost and inconvenience of AP will prevent it from becoming mainstream.
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Post by zuegirdor on Oct 25, 2017 14:51:48 GMT -5
Sorry for being a downer today, but I heard a radio show this morning on a local NPR station broadcast live from the Cleveland Clinic Medical Innovation Summit 2017 which provides a glimpse of big changes in the upcoming year for the Health Care industry - like the TED of healthcare. Dr. Michael Roizen, the Cleveland Clinic's Chief Wellness officer and author (or, coauthor) of five number 1 NY Times Bestseller books (including the “You” series, starting with "You: The Owner's Manual") presented the best upcoming innovations to change the state of health care for 2018. The top product that he reviewed was a Hybrid Closed-loop insulin delivery system that was referred to as an artificial pancreas for T1 diabetics (and can be used for T2's after more testing). It includes a remote monitoring service. I didn't hear him give specifics on the name or manufacturing company, and today’s radio article is not posted on the radio station's website yet, but I believe this hotlink reviews the system he referred to: www.seas.harvard.edu/news/2017/10/artificial-pancreas-performs-well-in-clinical-trialIf this were used with Fiasp and marketed by the big pharma beneficiaries of this system, it would be big competition for Afrezza, despite Fiasp’s inferiority. I invite everyone to shoot holes in this. The link seems to show a closed-loop rather than hybrid closed-loop. Hybrid implies some insulin dosing is being done manually rather than with pump (at least I think that is the common usage of that term). Afrezza could be used with hybrid closed loop AP, and likely with some benefit... but offset by the fact that if there is already a pump with RAA (or Fiasp... though the injection site issues of Fiasp might be exacerbated with a pump), would the benefit outweigh the downside of adding manual dosing to what could otherwise be fully automated. Setting that aside, however, I'd argue that one could probably get as good results (possibly better) using Tresiba and Afrezza. Yes, it is not automated, but an AP system adds a heck of a lot of extra cost for payers and involves two invasive devices hanging off one's body 24/7. I won't claim to know with any certainty what fraction of patients would prefer an AP system to a combo like Tresiba and Afrezza, but I am certainly comfortable with my bet on Afrezza (at least with regard to this potential AP threat). Add in non-invasive BG meters (hopefully within next 24 months) and I think the case for Tresiba+Afrezza over pump looks even more attractive. I'm pretty certain I'd prefer Tresiba+Afrezza vs AP if I'm ever faced with that choice. Dual hormone APs (insulin + glucagon) would likely be the most serious challenge to Afrezza. My kid has already and repeatedly declined insulin pumps, including the new hybrid that were offered us FREE of charge through our medical plan (Kaiser) No thanks, we would rather pay out of pocket (since they decided to sock it to us by refusing to Rx him Afrezza) for Afrezza. Hows that for testimonial on both approaches! We were musing last month that as we near the end of his current Afrezza refill, our moods dip. Then the day or two before the delivery, the anticipation builds. Then the day we see the package at the door its like Christmas. No kidding. Who gets excited about medicine coming to their door? Shoot, we do! Sounds corny but its the TRUTH. Afrezza really is FREEDOM. Freedom that we celebrate like the 4th of July every month. Its like we still can't believe the miracle: that somehow we managed to improve our lives by pushing back on the system. One of the few times I ever fought the system and won! |
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Post by sportsrancho on Oct 25, 2017 14:54:39 GMT -5
Sorry for being a downer today, but I heard a radio show this morning on a local NPR station broadcast live from the Cleveland Clinic Medical Innovation Summit 2017 which provides a glimpse of big changes in the upcoming year for the Health Care industry - like the TED of healthcare. Dr. Michael Roizen, the Cleveland Clinic's Chief Wellness officer and author (or, coauthor) of five number 1 NY Times Bestseller books (including the “You” series, starting with "You: The Owner's Manual") presented the best upcoming innovations to change the state of health care for 2018. The top product that he reviewed was a Hybrid Closed-loop insulin delivery system that was referred to as an artificial pancreas for T1 diabetics (and can be used for T2's after more testing). It includes a remote monitoring service. I didn't hear him give specifics on the name or manufacturing company, and today’s radio article is not posted on the radio station's website yet, but I believe this hotlink reviews the system he referred to: www.seas.harvard.edu/news/2017/10/artificial-pancreas-performs-well-in-clinical-trialIf this were used with Fiasp and marketed by the big pharma beneficiaries of this system, it would be big competition for Afrezza, despite Fiasp’s inferiority. I invite everyone to shoot holes in this. It’s attached to your body. No competition. |
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Post by dreamboatcruise on Oct 25, 2017 15:00:58 GMT -5
The link seems to show a closed-loop rather than hybrid closed-loop. Hybrid implies some insulin dosing is being done manually rather than with pump (at least I think that is the common usage of that term). Afrezza could be used with hybrid closed loop AP, and likely with some benefit... but offset by the fact that if there is already a pump with RAA (or Fiasp... though the injection site issues of Fiasp might be exacerbated with a pump), would the benefit outweigh the downside of adding manual dosing to what could otherwise be fully automated. Setting that aside, however, I'd argue that one could probably get as good results (possibly better) using Tresiba and Afrezza. Yes, it is not automated, but an AP system adds a heck of a lot of extra cost for payers and involves two invasive devices hanging off one's body 24/7. I won't claim to know with any certainty what fraction of patients would prefer an AP system to a combo like Tresiba and Afrezza, but I am certainly comfortable with my bet on Afrezza (at least with regard to this potential AP threat). Add in non-invasive BG meters (hopefully within next 24 months) and I think the case for Tresiba+Afrezza over pump looks even more attractive. I'm pretty certain I'd prefer Tresiba+Afrezza vs AP if I'm ever faced with that choice. Dual hormone APs (insulin + glucagon) would likely be the most serious challenge to Afrezza. My kid has already and repeatedly declined insulin pumps, including the new hybrid that were offered us FREE of charge through our medical plan (Kaiser) No thanks, we would rather pay out of pocket (since they decided to sock it to us by refusing to Rx him Afrezza) for Afrezza. Hows that for testimonial on both approaches! We were musing last month that as we near the end of his current Afrezza refill, our moods dip. Then the day or two before the delivery, the anticipation builds. then the day we see the package at the door its like Christmas. No kidding. Who gets excited about medicine coming to their door? Shoot, we do! Sounds corny but its the TRUTH. Afrezza really is FREEDOM. Freedom that we celebrate like the 4th of July every month. Its like we still can't believe the miracle: that somehow we managed to improve out lives by pushing back on the system. One of the few times I ever fought the system and won! Which Kaiser are you with? I know SoCal doesn't cover Afrezza at all. Take the new label in next time you've got an appt, and make a strong case for the fact that dealing with delayed insulin clearing results in poorer control as well as unmeasurable impact to quality of life simply from having to worry about it. [Or whatever your argument would be... not meaning to actually guess what would matter to you, but simply making the point it might be time to revisit trying to knock some sense into Kaiser armed with the table that more clearly shows Afrezza's speed compared to RAA] |
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Post by zuegirdor on Oct 25, 2017 15:02:23 GMT -5
The link seems to show a closed-loop rather than hybrid closed-loop. Hybrid implies some insulin dosing is being done manually rather than with pump (at least I think that is the common usage of that term). Afrezza could be used with hybrid closed loop AP, and likely with some benefit... but offset by the fact that if there is already a pump with RAA (or Fiasp... though the injection site issues of Fiasp might be exacerbated with a pump), would the benefit outweigh the downside of adding manual dosing to what could otherwise be fully automated. Setting that aside, however, I'd argue that one could probably get as good results (possibly better) using Tresiba and Afrezza. Yes, it is not automated, but an AP system adds a heck of a lot of extra cost for payers and involves two invasive devices hanging off one's body 24/7. I won't claim to know with any certainty what fraction of patients would prefer an AP system to a combo like Tresiba and Afrezza, but I am certainly comfortable with my bet on Afrezza (at least with regard to this potential AP threat). Add in non-invasive BG meters (hopefully within next 24 months) and I think the case for Tresiba+Afrezza over pump looks even more attractive. I'm pretty certain I'd prefer Tresiba+Afrezza vs AP if I'm ever faced with that choice. Dual hormone APs (insulin + glucagon) would likely be the most serious challenge to Afrezza. Closed loops are absolute nightmares if not calibrated frequently and accurately. It’s nearly impossible to get a pump to change directions without overshooting the desired set point resulting in higher and lower doses of whatever it is you are feeding, until the pump stabilizes. I can imagine when dosing something like Insulin, these fluctuations would happen after every meal !! I can’t see them getting it done without paying special attention to fluctuating mealtime glucose levels, which in my opinion, takes a lot of the automation out of it. I agree 100%, they will get better glucose levels easier with Tresiba and Afrezza. This will only be an issue until more PWD learn of the Tresiba/Afrezza combination. 👀 Add to what you said about calibrating and fluctuating glucose, the fact that foreign body rejection, infusion line occlusion and infusion site irritation are not just uncomfortable but can lead to serious under and over dosing and infections. It happens. I don't have frequency data handy but I have read accounts of pump caused hypo and hyper glycemia. Also have read (sorry no link to studies) that average A1c are not that impressive, something just on the verge of the more recent target recommendations of 7 or less. I want to say the average I remember for pumps being around 7.3...? My kid's latest on A1c Afrezza was 6.0. We go in on the 9th of Nov for another test. He has been nailing it lately with Afrezza. I won't be surprised if he pulls a 5.8. but I am getting ahead of myself... |
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Post by zuegirdor on Oct 25, 2017 15:09:47 GMT -5
Which Kaiser are you with? I know SoCal doesn't cover Afrezza at all. Take the new label in next time you've got an appt, and make a strong case for the fact that dealing with delayed insulin clearing results in poorer control as well as unmeasurable impact to quality of life simply from having to worry about it. [Or whatever your argument would be... not meaning to actually guess what would matter to you, but simply making the point it might be time to revisit trying to knock some sense into Kaiser armed with the table that more clearly shows Afrezza's speed compared to RAA] Norcal He's pediatric patient. They won't touch it. But he turns 18 in 4 months. We will take your advice and bring the label in with us for that first adult appointment. A lot can change in 4 months, maybe? With a little advertising and a new label? His doc is actually softening up on the idea, if not the practice. I told her two years ago that she would thank me someday for being the first to tell her about Afrezza. She has not gone that far yet  |
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Post by esstan2001 on Oct 25, 2017 15:20:16 GMT -5
rockstarrick ... there is variability in absorption dynamics (such as caused by hydration level), so it really isn't even possible to just have a calibrated electro-mechanical pump system. An AP really has to adjust for end to end dynamics using the CGM. Dual hormone helps with the issue of overshooting. I haven't really tracked the research in APs to see what level of time in range they are achieving, as my basic thesis on Afrezza is that even if an AP can match the results, the cost and inconvenience of AP will prevent it from becoming mainstream. So DBC... you are finally coming around to Al Mann's conclusion regarding pumps (his last major paradigm in Diabetes treatment) and Afrezza  |
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Post by MnkdWASmyRtrmntPlan on Oct 25, 2017 15:36:04 GMT -5
rockstarrick ... there is variability in absorption dynamics (such as caused by hydration level), so it really isn't even possible to just have a calibrated electro-mechanical pump system. An AP really has to adjust for end to end dynamics using the CGM. Dual hormone helps with the issue of overshooting. I haven't really tracked the research in APs to see what level of time in range they are achieving, as my basic thesis on Afrezza is that even if an AP can match the results, the cost and inconvenience of AP will prevent it from becoming mainstream. So DBC... you are finally coming around to Al Mann's conclusion regarding pumps (his last major paradigm in Diabetes treatment) and Afrezza What did Al say about pumps? |
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Post by brentie on Oct 25, 2017 15:42:42 GMT -5
Sorry for being a downer today, but I heard a radio show this morning on a local NPR station broadcast live from the Cleveland Clinic Medical Innovation Summit 2017 which provides a glimpse of big changes in the upcoming year for the Health Care industry - like the TED of healthcare. Dr. Michael Roizen, the Cleveland Clinic's Chief Wellness officer and author (or, coauthor) of five number 1 NY Times Bestseller books (including the “You” series, starting with "You: The Owner's Manual") presented the best upcoming innovations to change the state of health care for 2018. The top product that he reviewed was a Hybrid Closed-loop insulin delivery system that was referred to as an artificial pancreas for T1 diabetics (and can be used for T2's after more testing). It includes a remote monitoring service. I didn't hear him give specifics on the name or manufacturing company, and today’s radio article is not posted on the radio station's website yet, but I believe this hotlink reviews the system he referred to: www.seas.harvard.edu/news/2017/10/artificial-pancreas-performs-well-in-clinical-trialIf this were used with Fiasp and marketed by the big pharma beneficiaries of this system, it would be big competition for Afrezza, despite Fiasp’s inferiority. I invite everyone to shoot holes in this. Here's what Al had to say on the subject... SF: I know you’ve been involved with the artificial pancreas and there’s been a lot of new information coming out, some trials that have proven successful. Do you really think that there is going to be, some day, an artificial pancreas, a machine that will control someone’s life that could go wrong and actually kill someone, possibly? The FDA is probably going to require so many tests and studies to be done. Do you ever think it is a possibility that it could happen? AM: I have to answer that in two ways. First of all, will an artificial pancreas be created that could effectively and safely control glucose levels in diabetes? I believe the answer to that question is “yes.” Do I think that it should be developed, and for the following reason I believe the answer to that question is “probably not.” After introduction of insulin pumps by MiniMed over thirty years ago, and soon afterward also glucose sensors, only 35% of people with type 1 diabetes in the United States are using insulin pumps, even fewer outside the United States, and hardly any type 2s globally. While insulin pumps do provide the best insulin therapy today, they don’t adequately address what I call my three Cs: cost, convenience and complexity. They are too expensive. They are too complicated. They are too inconvenient. I believe that a combination of Afrezza plus a reasonable basal insulin may not provide glucose control quite as good as by an artificial pancreas, the results would not be much poorer and would actually be good enough so that I don’t really see a real business opportunity for such a sophisticated and expensive system as the artificial pancreas. Surely there will likely be some type 1 patients that would use an artificial pancreas but the real need is for therapy that would be much more widely used. www.diabetesincontrol.com/an-exclusive-interview-with-al-mann-founder-and-ceo-mannkind-corp/ |
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Post by MnkdWASmyRtrmntPlan on Oct 25, 2017 15:53:00 GMT -5
Wow!
You all pulled me out of my slump from hearing that negative news this morning.
I love you guys. This board is great. Great answers. Even Al pulled through.
Thanks, everyone.
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