American Assn of Clinical Endocrinologists Type 2 Algorithm

[mnholdem]

AACE/ACE Comprehensive Type 2 Diabetes Management Algorithm

Link: www.aace.com/publications/algorithm  and click "Slide Presentation". This PowerPoint may take a few minutes to download. I do not know if the presentation is compatible for mobile devices.

AACE/ACE Algorithm Permission and Reprint Requests: This material is protected by US copyright law. Individuals are permitted to use algorithm slides for educational, non-promotional presentations. For permission to reuse the material in any other format, including reproducing multiple copies, visit AACE Permissions. To purchase commercial reprints, visit AACE Reprints.

[boca1girl]

My take aways:

Metformin still front and center.
A1C now less than or equal to 6.5.
Inhaled insulin included in the insulin category.
None of the doctors are being paid by MNKD.

[mnholdem]

In my opinion, it should be considered a serious omission that the algorithm does not list the more serious side-effects of the various treatments in the algorithm. To their credit, however, the AADE/ACE algorithm does list certain risk factors in the Profile of Antidiabetic Medications section, covering risk profiles for Metformin, GLP-A RA, SGLT-2i, SSP-4i, AGi, TZD, SU/GLN, COLSVL, BCR-QR, INSULIN and PRAML for the following health risks:

• HYPO
• WEIGHT
• RENAL/GU
• GI Sx
• CARDIAC (CHF)
• CARDIAC (ASCVD)
• BONE
• KETOACIDOSIS

In a manner similar to the Diabetes Standard of Care by the American Diabetes Association, the AACE/ACE algorithm labels insulin as being associated with a "Moderate to Severe" risk of hypoglycemia.

I think that it may take some time and involve several trials to convince the AACE/ACE and the ADA that certain Ultra-Rapid Acting Insulin treatments, like Afrezza^(R) Inhalable Insulin (human), actually present only a Neutral to Mild hypo risk. But you should expect resistance by the AACE/ACE to the idea of moving URAI treatment much earlier in the algorithm because they can simply cite other concerns. For Afrezza^(R) a few publications by members have cited that lung safety remains unknown for inhaled insulin. Even though there is over ten years of trial data involving over 6,000 patients, demonstrating virtually no safety problems (the few recorded adverse events involved smokers) this issue won't be fully addressed until the results of the FDA-mandated post-market safety trials are published. At present, the requirement is a 5-year study but, with the FDA recently indicating that it will begin accepting real world data, the trial may be shortened. 

[peppy]

Jan 19, 2018 8:18:16 GMT -5 mnholdem said:

AACE/ACE Comprehensive Type 2 Diabetes Management Algorithm

Link: www.aace.com/publications/algorithm  and click "Slide Presentation". This PowerPoint may take a few minutes to download. I do not know if the presentation is compatible for mobile devices.

AACE/ACE Algorithm Permission and Reprint Requests: This material is protected by US copyright law. Individuals are permitted to use algorithm slides for educational, non-promotional presentations. For permission to reuse the material in any other format, including reproducing multiple copies, visit AACE Permissions. To purchase commercial reprints, visit AACE Reprints.

This material is protected by US copyright law. Individuals are permitted to use algorithm slides for educational, non-promotional presentations.

For our education,

not much difference

[sayhey24]

Page 8 of this document says "Insulin is the most potent antihyperglycemic agent." So what is all this crap about Metformin, TZDs, DDP-4, SGLT-2 and GLP-1s?

Then it gets worse. The problem all t2s have is the after meal BG spike. What does the AAEC say to use, basal!

My question for the AAEC is when are they going to get honest? Let me rewrite this document in a few sentences.

When diagnosed take insulin as it is the most potent antihyperglycemic agent (their words not mine). Since the first issue T2s have is loss of a robust first phase insulin release after a meal, the T2 needs to address this issue and "stop the spike". Currently there are only two reliable ways to stop the spike; a healthy pancreas and afrezza. Upon initial diagnosis of elevated blood glucose levels all patients should obtain a minimum two week AGP. If the PWD shows any elevated BG based on the AGP the PWD should immediately be put on a diet/exercise program and afrezza.

None of this other crap is needed anymore. afrezza changes the paradigm.

[peppy]

Jan 23, 2018 19:56:24 GMT -5 sayhey24 said:

Page 8 of this document says "Insulin is the most potent antihyperglycemic agent." So what is all this crap about Metformin, TZDs, DDP-4, SGLT-2 and GLP-1s?

Then it gets worse. The problem all t2s have is the after meal BG spike. What does the AAEC say to use, basal!

My question for the AAEC is when are they going to get honest? Let me rewrite this document in a few sentences.

When diagnosed take insulin as it is the most potent antihyperglycemic agent (their words not mine). Since the first issue T2s have is loss of a robust first phase insulin release after a meal, the T2 needs to address this issue and "stop the spike". Currently there are only two reliable ways to stop the spike; a healthy pancreas and afrezza. Upon initial diagnosis of elevated blood glucose levels all patients should obtain a minimum two week AGP. If the PWD shows any elevated BG based on the AGP the PWD should immediately be put on a diet/exercise program and afrezza.

None of this other crap is needed anymore. afrezza changes the paradigm.

So what is all this crap about Metformin, TZDs, DDP-4, SGLT-2 and GLP-1s?   you know sayhey,  prior to Afrezza mealtime insulin too dangerous for T2, written allover the standards care with the yellow exclamation point.

reply: the medical industry can hand out metformin for 40 cents a tablet. x 365= $146/year.  

from nadathing:
My BCBS plan covers Afrezza
$150 copay for 3 months. Prior authorixation needed.

Note on site:
You pay 3% of the cost.
Your Plan pays $4,800.62 / 3 months

Almost $15,000 a year? Wow

Honesty? Really? I have cable TV and news. Honesty?

[mango]

Jan 23, 2018 19:56:24 GMT -5 sayhey24 said:

Page 8 of this document says "Insulin is the most potent antihyperglycemic agent." So what is all this crap about Metformin, TZDs, DDP-4, SGLT-2 and GLP-1s?

Then it gets worse. The problem all t2s have is the after meal BG spike. What does the AAEC say to use, basal!

My question for the AAEC is when are they going to get honest? Let me rewrite this document in a few sentences.

When diagnosed take insulin as it is the most potent antihyperglycemic agent (their words not mine). Since the first issue T2s have is loss of a robust first phase insulin release after a meal, the T2 needs to address this issue and "stop the spike". Currently there are only two reliable ways to stop the spike; a healthy pancreas and afrezza. Upon initial diagnosis of elevated blood glucose levels all patients should obtain a minimum two week AGP. If the PWD shows any elevated BG based on the AGP the PWD should immediately be put on a diet/exercise program and afrezza.

None of this other crap is needed anymore. afrezza changes the paradigm.

The ADA, AACE and ACE all know they are wrong. In their minds (not mine) it would be (is) a complete embarrassment to admit that they have been wrong this entire time, and have delayed and hindered the appropriate treatment for T2D. With all the new clinical trials MannKind has done and is doing and all the data that will be coming out from those, it is going to be extremely difficult to defend their current Standards of Care. It is irresponsible and dangerous what they are doing.