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Post by mango on Nov 23, 2017 3:12:40 GMT -5
A new Endo Consensus statement on clinically meaningful outcome measures beyond the single measurement of HbA1C is discussed. The financial disclosures illustrates the Consensus’ bias to their respected companies of which they receive financial reward from. All in all, I remain disappointed that the Endo Consensus continues to ignore the importance of restoring the early-phase insulin response and its role not only in T2D but also T1D. Restoring post-prandial glucose homeostasis appears to not be of importance to the Consensus. MannKind science and the evidence of Afrezza with CGMs will eventually prevail and people with diabetes will eventually live non-diabetic or near non-diabetic lives. That’s my hope. Standardizing Clinically Meaningful Outcome Measures Beyond HbA1C for Type 1 Diabetes: A Consensus Report of the American Association of Clinical Endocrinologists, the American Association of Diabetes Educators, the American Diabetes Association, the Endocrine Society, JDRF International, The Leona M. and Harry B. Helmsley Charitable Trust, the Pediatric Endocrine Society, and the T1D Exchange Acknowledgments. The authors acknowledge the contributions of each of the Steering Committee organizations. Each of these organizations endorses the standardizing of clinically meaningful outcome measures beyond HbA1c for type 1 diabetes. The authors acknowledge the valuable contributions of Marisa Hilliard (Baylor College of Medicine), Barbara Anderson (Baylor College of Medicine), and Stephen Joel Koons (Critical Path Institution). The authors also acknowledge the contributions made by the members of the Advisory Committees, whose input helped in the development of this article, and the staff support from the AADE, the ADA, Discern Health, the Endocrine Society, and JDRF International. Funding. JDRF provided funding for the Type 1 Diabetes Outcomes Program, funded in part by a grant from The Leona M. and Harry B. Helmsley Charitable Trust. Duality of Interest. L.B. is a consultant for AstraZeneca, Bristol-Myers Squibb, Eisai, GlaxoSmithKline, Janssen, Merck, Novo Nordisk, Quest Diagnostics, and Sanofi. His institution, Ochsner Clinic, receives grant/research support from Eli Lilly, Novo Nordisk, and Sanofi. He is a member of the speakers’ bureaus for Amylin, AstraZeneca, Bristol-Myers Squibb, Janssen, Merck, Novo Nordisk, Quest Diagnostics, and Sanofi. P.M. has received compensation as an employee at the ADA. A.H.M.-F. has received personal fees from Novo Nordisk Cardiovascular Disease Advisory Panel. A.P. has been an advisor, board member, and consultant or speaker for Abbott Diabetes Care, Becton Dickinson, Bigfoot Biomedical, Boehringer Ingelheim, Dexcom, Eli Lilly, Janssen, Lexicon, Livongo, Medscape, Merck, Novo Nordisk, Omada Health, Sanofi, and Science 37. S.A.W. has received personal fees from Medtronic and Insulet. He also serves on the Advisory Committee and receives stock shares from Insuline Medical. No other potential conflicts of interest relevant to this article were reported. care.diabetesjournals.org/content/diacare/40/12/1622.full.pdf |
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Post by dreamboatcruise on Nov 25, 2017 14:15:52 GMT -5
Interesting that 180 was chosen as the threshold definition for hyperglycemia and upper limit for "time in range". I've seen people here on PB state that damage occurs above 140 but I'm not sure anyone has provided reference to what research supports that.
I wonder how many on RAA prandial could manage the 70-180 time in range if they had a CGM.
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Post by agedhippie on Nov 25, 2017 16:29:40 GMT -5
Interesting that 180 was chosen as the threshold definition for hyperglycemia and upper limit for "time in range". I've seen people here on PB state that damage occurs above 140 but I'm not sure anyone has provided reference to what research supports that. I wonder how many on RAA prandial could manage the 70-180 time in range if they had a CGM. The average of 180 to 70 is 125 which translates into a sub 6.0 Alc. In other words if you can hit that your chances of complications are very low. The 140 number comes from that being the typical maximum that a non-diabetic sees, and is also the point around which your body starts spilling glucose into your urine which is how it regulates things normally. There is an assumption that if the body spills glucose it is in some way being damaged. There are not a lot of long term studies on most of this with a few exceptions. The best one is the UKPDS which has followed a group of 5000 T2 diabetics starting in 1977 until 1997 with the groups split into intensive and regular care. There was a follow on study lasting another 10 years of all the surviving participants ending in 2007. The cohort is still tracked and from time to time you will see papers about them. This gives a 30+ year view of the progression of diabetes and the impact of treatments. For T2 the UKPDS is the gold standard of T2 studies. What the UKPDS proved conclusively for the first time was that control of glucose levels in Type 2 was a good thing. It also showed that control of blood pressure was critical for Type 2 (nobody ever talks about that but ACE inhibitors were a huge step forwards - it reduces blood vessel related (stroke, heart attack, vision, kidney) damage and death by a third independent of glucose level controls. These are all things we take for granted now but where proven in the UKPDS. |
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Post by sayhey24 on Nov 26, 2017 9:19:34 GMT -5
Interesting that 180 was chosen as the threshold definition for hyperglycemia and upper limit for "time in range". I've seen people here on PB state that damage occurs above 140 but I'm not sure anyone has provided reference to what research supports that. I wonder how many on RAA prandial could manage the 70-180 time in range if they had a CGM. The 180 number has been around awhile. Here is an example www.thediabetescouncil.com/what-are-blood-sugar-target-ranges/The "new" number came from a negotiation of the "thought leaders" at the BeyondA1c Forum this past July. Some wanted 150 others 200. Its basically a meaningless number. Non-diabetics typically do not exceed 140 and are back to baseline <90 in about 2 hours. The reference to 140 is that microvascular blood vessels rupture when exposed to high sugar. We know this happens when people who have 2 hours plus exposure. Here is an example cardiab.biomedcentral.com/articles/10.1186/1475-2840-8-23. Is 140 hard and fast, probably not but its not a bad general target number. How many on RAA prandial could manage the 70-180 time in range if they had a CGM? Any insulin could keep this range if magically timed. The problem is timing the speed of absorption with the rise in sugar. This is the challenge systems like SugarIQ have been working on and some of the algorithms brought to the table by Google into the Ondou venture. onduo.com Its a really hard problem as there are so many variables. Moreover, with afrezza this problem becomes a non-issue, problem solved. The other question is how many T2s on oral meds are seeing their BG rise above 180? The answer is most. In fact most 70%+ are not meeting an average 154 or A1c 7. Then again how many "pre-diabetics" are hitting 180? |
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Post by peppy on Nov 26, 2017 11:21:46 GMT -5
Interesting that 180 was chosen as the threshold definition for hyperglycemia and upper limit for "time in range". I've seen people here on PB state that damage occurs above 140 but I'm not sure anyone has provided reference to what research supports that. I wonder how many on RAA prandial could manage the 70-180 time in range if they had a CGM. The 180 number has been around awhile. Here is an example www.thediabetescouncil.com/what-are-blood-sugar-target-ranges/The "new" number came from a negotiation of the "thought leaders" at the BeyondA1c Forum this past July. Some wanted 150 others 200. Its basically a meaningless number. Non-diabetics typically do not exceed 140 and are back to baseline <90 in about 2 hours. The reference to 140 is that microvascular blood vessels rupture when exposed to high sugar. We know this happens when people who have 2 hours plus exposure. Here is an example cardiab.biomedcentral.com/articles/10.1186/1475-2840-8-23. Is 140 hard and fast, probably not but its not a bad general target number. How many on RAA prandial could manage the 70-180 time in range if they had a CGM? Any insulin could keep this range if magically timed. The problem is timing the speed of absorption with the rise in sugar. This is the challenge systems like SugarIQ have been working on and some of the algorithms brought to the table by Google into the Ondou venture. onduo.com Its a really hard problem as there are so many variables. Moreover, with afrezza this problem becomes a non-issue, problem solved. The other question is how many T2s on oral meds are seeing their BG rise above 180? The answer is most. In fact most 70%+ are not meeting an average 154 or A1c 7. Then again how many "pre-diabetics" are hitting 180? T2 example, 12 units in the am, 20 units at lunch, 30 units dinner plus corrections, = 62 units. 62 units times $1.27 per unit = $78.74. 62 units a day times 30 days = 1860 units. the 1440 unit titration pack times $1.27 per unit = $1,828.80.
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Post by dreamboatcruise on Nov 26, 2017 15:37:16 GMT -5
The reference to 140 is that microvascular blood vessels rupture when exposed to high sugar. We know this happens when people who have 2 hours plus exposure. Here is an example cardiab.biomedcentral.com/articles/10.1186/1475-2840-8-23. Is 140 hard and fast, probably not but its not a bad general target number. The link above doesn't work for me. Can you provide a different link or the title of the paper? Thx |
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rwp
Newbie
Posts: 24 
Sentiment: Long
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Post by rwp on Nov 26, 2017 15:45:38 GMT -5
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Post by babaoriley on Nov 26, 2017 17:43:19 GMT -5
The reference to 140 is that microvascular blood vessels rupture when exposed to high sugar. We know this happens when people who have 2 hours plus exposure. Here is an example cardiab.biomedcentral.com/articles/10.1186/1475-2840-8-23. Is 140 hard and fast, probably not but its not a bad general target number. The link above doesn't work for me. Can you provide a different link or the title of the paper? Thx Try this link, DBC: voteyes.toauthorize140-millionmoreshares/com |
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Post by dreamboatcruise on Nov 27, 2017 14:56:25 GMT -5
The link above doesn't work for me. Can you provide a different link or the title of the paper? Thx Try this link, DBC: voteyes.toauthorize140-millionmoreshares/com Or this tried and true link... JustSayNo.com |
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Post by sayhey24 on Nov 27, 2017 20:30:11 GMT -5
The reference to 140 is that microvascular blood vessels rupture when exposed to high sugar. We know this happens when people who have 2 hours plus exposure. Here is an example cardiab.biomedcentral.com/articles/10.1186/1475-2840-8-23. Is 140 hard and fast, probably not but its not a bad general target number. The link above doesn't work for me. Can you provide a different link or the title of the paper? Thx Works great for me - try this cardiab.biomedcentral.com/articles/10.1186/1475-2840-8-23If that doesn't work do the google and paste it into the search. There are a lot of good references in the article. The bottom line is post prandial sugar spikes are of huge vascular concern. If I were Mike I would be following the Jardiance lead about heart health. Nothing can stop the spike better than afrezza and get the PWD back to baseline sooner. |
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Post by sayhey24 on Nov 27, 2017 20:33:16 GMT -5
its stripping the "https://" off the front - you may have to add that back in your browser
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