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ADA
Jan 28, 2018 10:46:50 GMT -5
digger likes this
Post by agedhippie on Jan 28, 2018 10:46:50 GMT -5
Yes, very few doctors are going to go contrary to the standard of care because of the risk. Until the standard of care changes people can say what they like but metformin is here to stay as the first line treatment and prandial insulin will remain the last resort. but, CGM will quickly shed light on the inadequacy of current treatments and the standard of care will change. That will require large scale trials and they are not happening yet. That's before you get to the cost implications of using insulin as a first line treatment at 100 times the cost of metformin multiplied by the number of diabetics - how does that get paid for? The usual answer is in reduced treatment costs down the line, but that would need to be evidenced.
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Post by straightly on Jan 29, 2018 2:11:17 GMT -5
but, CGM will quickly shed light on the inadequacy of current treatments and the standard of care will change. That will require large scale trials and they are not happening yet. That's before you get to the cost implications of using insulin as a first line treatment at 100 times the cost of metformin multiplied by the number of diabetics - how does that get paid for? The usual answer is in reduced treatment costs down the line, but that would need to be evidenced. My hope is that CGM will cause such a uproar among diabetes that they will search the internet for better control of their bg level which will lead them to try Afrezza. Only if that could happen quicker!
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Post by mango on Jan 29, 2018 2:23:08 GMT -5
but, CGM will quickly shed light on the inadequacy of current treatments and the standard of care will change. That will require large scale trials and they are not happening yet. That's before you get to the cost implications of using insulin as a first line treatment at 100 times the cost of metformin multiplied by the number of diabetics - how does that get paid for? The usual answer is in reduced treatment costs down the line, but that would need to be evidenced. The kind of clinical trials that you are suggesting will not happen, but not because of money but because they are completely unnecessary. We know that all the pills and basal insulin cannot address the underlying issue in people with T2D. We already know there is progresssive beta-cell failure due to dysregulation in post-prandial glucose homeostasis from the loss of the first-phase insulin response. This is well established and unfortunately what the ADA has been recommending for all these years has been inadequate, a failure and does not solve the problem. Before Afrezza there was a stigma hovering over prandial insulins (hypoglycemia). Now that Afrezza is here, we don't have that risk and we can now safely solve the problem of post-prandial hyperglycemia due to loss of the first-phase insulin response. We don't need clinical trials to tell us that Metformin and basal insulin cannot restore the FPIR, cannot stop beta-cell failure and cannot solve post-prandial hyperglycemia in T2D.
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Post by casualinvestor on Jan 29, 2018 10:11:36 GMT -5
What PCP wants to hear about an easy to dose insulin? They have been taught "insulin is dangerous" Ralph DeFronzo has built an entire career on "insulin is dangerous". My pitch is a bit harder " Do you want to potentially stop the progression and save your PWDs from all the complications including heart disease and death?" Easy, "Stop the Spike, get "back to baseline" asap, "keep TIR near non-diabetic" and the body will do the rest. We have 40+ years of early insulin intervention studies, they all same the same that early use of insulin is best. None were done with afrezza which would only improve their results. We have the AACE which says insulin is the most potent agent. This science is settled. There are only TWO things which can consistently "Stop the Spike" - a healthy pancreas AND afrezza. There is no need to play Russian Roulette with an insulin needle. I suspect most PCPs want to hear that there is an easy to dose insulin. My PCP has anyone who needs to go on insulin go to an endo and expect there are a lot like that. There is a perception that it is hard to titrate and it is better that an expert does it. Being able to manage insulin without involving an endo would be a plus I would think (but I might be wrong as I have nothing to base that on other than gut feeling). None of the points you bring up can be used by reps since they are counter to the label. There are no trials to support any of that with Afrezza. This may change with STAT but even that has to wait for a label change. The reps have to work within the label, those are the FDA rules. It's not just the PCPs, it's also the patients. You don't have to be needle phobic to not want to stick yourself. People motivated to control diabetes will do the work to get the best result. Insulin, low-carb, exercise, constant checking, etc. Then there's the rest of us. Snap-click-inhale, and a few test strips just seems like a much lower barrier to insulin treatment than 3-daily injections and the problems that come with that. But without coverage and educated docs, Afrezza will not get to the "less-motivated" population. And without mass demand or superiority, you can't get insurance coverage. And so MNKD has slow growth and a needs to be very careful with money until Afrezza can finally break out
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Post by sayhey24 on Jan 29, 2018 19:52:14 GMT -5
That will require large scale trials and they are not happening yet. That's before you get to the cost implications of using insulin as a first line treatment at 100 times the cost of metformin multiplied by the number of diabetics - how does that get paid for? The usual answer is in reduced treatment costs down the line, but that would need to be evidenced. The kind of clinical trials that you are suggesting will not happen, but not because of money but because they are completely unnecessary. We know that all the pills and basal insulin cannot address the underlying issue in people with T2D. We already know there is progresssive beta-cell failure due to dysregulation in post-prandial glucose homeostasis from the loss of the first-phase insulin response. This is well established and unfortunately what the ADA has been recommending for all these years has been inadequate, a failure and does not solve the problem. Before Afrezza there was a stigma hovering over prandial insulins (hypoglycemia). Now that Afrezza is here, we don't have that risk and we can now safely solve the problem of post-prandial hyperglycemia due to loss of the first-phase insulin response. We don't need clinical trials to tell us that Metformin and basal insulin cannot restore the FPIR, cannot stop beta-cell failure and cannot solve post-prandial hyperglycemia in T2D. We have been talking about CGMs the Cloud and its impacts for over two years. It appears Mike Hoskins is starting to agree with us. "health insurance providers to have strong incentives to provide patients with the latest technology (CGM and data sharing) and tie success with those tools to cost savings. Thumbs up! "... "In fact, other payers are already creating similar alliances with medtech players, such as the Blue Cross and Blue Shield plans including Anthem that have partnered with Google-Sanofi-backed venture Onduo to monitor glucose levels in PWDs, using a yet-to-be-unveiled wearable device. A pilot is beginning this year" It appears insurance companies are not going to wait for years of clinical trials. Steve Edelman knows afrezza works and now we have a 9 year afrezza user saying she has never felt this good in 50 years. It looks like money talks and BS clinicals can walk. www.healthline.com/diabetesmine/fitbit-diabetes-united-healthcare#3It will soon be time to sit back and watch the show.
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Post by agedhippie on Jan 29, 2018 23:56:07 GMT -5
The kind of clinical trials that you are suggesting will not happen, but not because of money but because they are completely unnecessary. We know that all the pills and basal insulin cannot address the underlying issue in people with T2D. We already know there is progresssive beta-cell failure due to dysregulation in post-prandial glucose homeostasis from the loss of the first-phase insulin response. This is well established and unfortunately what the ADA has been recommending for all these years has been inadequate, a failure and does not solve the problem. Before Afrezza there was a stigma hovering over prandial insulins (hypoglycemia). Now that Afrezza is here, we don't have that risk and we can now safely solve the problem of post-prandial hyperglycemia due to loss of the first-phase insulin response. We don't need clinical trials to tell us that Metformin and basal insulin cannot restore the FPIR, cannot stop beta-cell failure and cannot solve post-prandial hyperglycemia in T2D. We have been talking about CGMs the Cloud and its impacts for over two years. It appears Mike Hoskins is starting to agree with us. "health insurance providers to have strong incentives to provide patients with the latest technology (CGM and data sharing) and tie success with those tools to cost savings. Thumbs up! "... "In fact, other payers are already creating similar alliances with medtech players, such as the Blue Cross and Blue Shield plans including Anthem that have partnered with Google-Sanofi-backed venture Onduo to monitor glucose levels in PWDs, using a yet-to-be-unveiled wearable device. A pilot is beginning this year" It appears insurance companies are not going to wait for years of clinical trials. Steve Edelman knows afrezza works and now we have a 9 year afrezza user saying she has never felt this good in 50 years. It looks like money talks and BS clinicals can walk. www.healthline.com/diabetesmine/fitbit-diabetes-united-healthcare#3It will soon be time to sit back and watch the show. The Standard of Care takes trial data to change. Not insurers, not bloggers, it takes trial data. This is about reducing the cost of medication and preventing people from progressing to insulin. The whole thing operates within the standard of care.
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Post by sayhey24 on Jan 30, 2018 18:41:14 GMT -5
Well, it sure looks like Amazon is not waiting for trials. If I remember what Dachis was saying at the shareholders meeting, he was trying to do a deal with Amazon. Not saying he is part of today's deal but I also would not be surprised. I also thought it was interesting Mike tweets the Amazon news and then challenges Adam F. Is Adam going to Danbury? Maybe Mike can make it an open debate and we can all go and see it.
Now, the best way to reduce health care costs is to keep non-diabetic BG and stopping the spike. Diabetes is a HUGE expense. If Al Mann was right and Ralph DeFronzo is right, keeping non-diabetic BG should stop the progression and actually show reversal. Do that in less than a year and not need meds for years following? Now that sounds like a cost savings. Keep them near non-diabetic BG and significantly reduce heart disease? Now that sounds like a huge cost savings. Keep them off the SGLT2s and other oral meds and save some toes and feet and legs and pancreatic cancer. Now that sounds like huge cost savings.
Its a funny thing about blood, it seem to affect a lot of the body. Its a funny thing about high BG, it also seems to affect a lot of the body.
Maybe Amazon, Dachis and Buffett are on to something. Then again maybe they have been reading this board for the last few years.
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ADA
Jan 30, 2018 18:48:03 GMT -5
via mobile
Post by ryster505 on Jan 30, 2018 18:48:03 GMT -5
Well, it sure looks like Amazon is not waiting for trials. If I remember what Dachis was saying at the shareholders meeting, he was trying to do a deal with Amazon. Not saying he is part of today's deal but I also would not be surprised. I also thought it was interesting Mike tweets the Amazon news and then challenges Adam F. Is Adam going to Danbury? Maybe Mike can make it an open debate and we can all go and see it. Now, the best way to reduce health care costs is to keep non-diabetic BG and stopping the spike. Diabetes is a HUGE expense. If Al Mann was right and Ralph DeFronzo is right, keeping non-diabetic BG should stop the progression and actually show reversal. Do that in less than a year and not need meds for years following? Now that sounds like a cost savings. Keep them near non-diabetic BG and significantly reduce heart disease? Now that sounds like a huge cost savings. Keep them off the SGLT2s and other oral meds and save some toes and feet and legs and pancreatic cancer. Now that sounds like huge cost savings. Its a funny thing about blood, it seem to affect a lot of the body. Its a funny thing about high BG, it also seems to affect a lot of the body. Maybe Amazon, Dachis and Buffett are on to something. Then again maybe they have been reading this board for the last few years. I have had the Oracle in the back of my head for quite some time. After all, one of the biggest advocates for pwd, as well as the biggest pockets..... www.google.com/amp/s/seekingalpha.com/amp/article/922741-warren-buffett-invests-in-a-diabetes-future
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ADA
Jan 30, 2018 18:51:40 GMT -5
Post by sayhey24 on Jan 30, 2018 18:51:40 GMT -5
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Post by ryster505 on Jan 30, 2018 18:59:58 GMT -5
Yes, this was a gem as well. My thoughts are either he is “all in” or “all out”...Hopefully the former. We shall see. Imagine waking up one morning just drab As F, expecting another unpredictable day on the playing field for MNKD, and at the top of the news feed we get a “Warren Buffett and Amazon team up with Mannkind to distribute Afrezza and Technosphere world wide!” The article is also a tandem venture between SO and AF...Ahhhh, what a day it WILL be...
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ADA
Jan 30, 2018 19:55:48 GMT -5
Post by mnkdfann on Jan 30, 2018 19:55:48 GMT -5
Don't leave us hanging ... what did he say back to you?
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Post by dreamboatcruise on Jan 30, 2018 20:13:29 GMT -5
Don't leave us hanging ... what did he say back to you? If I were a betting man... oh, wait, I invested in MNKD, so I am... I'd guess he didn't get a response. No judgement on what might have been written, just guessing Buffet gets far too much mail to read things from people he doesn't know.
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ADA
Jan 30, 2018 20:16:48 GMT -5
via mobile
xanet likes this
Post by tarheelblue004 on Jan 30, 2018 20:16:48 GMT -5
Don't leave us hanging ... what did he say back to you? He had to have said “Hey”. Ba dum tss
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Post by sayhey24 on Jan 31, 2018 6:42:50 GMT -5
Its a funny thing, you never know what to expect. Sending a cold email you would expect nothing back but sometimes you do. What I will say I learned is Buffett knew Al and his work. They were both part of the Giving Pledge.
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ADA
Jan 31, 2018 6:44:22 GMT -5
Post by #NoMoreNeedles on Jan 31, 2018 6:44:22 GMT -5
What happened to the Amgen theory!? They are at the opposite end now!
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