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Post by sayhey24 on Jul 5, 2018 6:48:09 GMT -5
Lets hope Dr. Kendall can close on what he said was the easiest job he has ever had. For the T1s the update is easy starting with bullet 2. For the T2s its a bit more messy with metformin all over the place. care.diabetesjournals.org/content/41/Supplement_1/S73I wonder how fisherman made out and if he ever got the Libre.
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Post by agedhippie on Jul 5, 2018 8:49:46 GMT -5
Lets hope Dr. Kendall can close on what he said was the easiest job he has ever had. For the T1s the update is easy starting with bullet 2. For the T2s its a bit more messy with metformin all over the place. care.diabetesjournals.org/content/41/Supplement_1/S73I wonder how fisherman made out and if he ever got the Libre. Have a look at the draft consensus statement for the ADA and EASD, there is a link to the presentation (all 2 hours of it, happily split into topics) at ADA 78 in the diabetes and other forum. Bottom line is that metformin will remain the first line treatment. Basal insulin gets pushed back a slot to third line (making prandial insulin 4th line). If you do not have CVD then second line is GLP-1. If you do have CVD then second line is SGLT-2 and/or GLP-1 with order priority depending on the type of CVD. The final version of this gets presented in Europe in October and will inform diabetes treatment policy for the next three years in Europe and the US. It's not that it will not be deviated from, but rather that the presumption is this is the strategy and deviation will require major trials.
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Post by sayhey24 on Jul 6, 2018 11:03:52 GMT -5
Aged - so what you are saying is Dr. Kendall has his work cut out for him or are what you are saying he is clueless and delusional? Mission one is to deliver for the T1s. As I have said several times it will take 18 months for afrezza to become step 2 for the T2s. Knowing what we know, afrezza smokes the GLP-1s and has basically obsoleted the need for them. Now what doctor in their right mind would treat T2 diabetics with a basal when they have a prandial which has near zero chance of hypos when not used with other medications? The big question will be should metformin remain step 1 or should it be; lose a few pounds; take a walk; and take the afrezza with each meal? As Ralph DeFronzo told us last year - “The most waste in type 2 diabetes is to continuously put people on metformin and sulfonylureas (glyburide, glimepiride, etc.). These drugs have no protective effect on the beta cell, and by the time you figure out what you’re doing, there are no beta cells left to save.” – Dr. Ralph DeFronzo (University of Texas Health Science Center) diatribe.org/the-diatribe-foundation-and-tcoyd-11th-annual-forum
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Post by goyocafe on Jul 6, 2018 11:15:24 GMT -5
Aged - so what you are saying is Dr. Kendall has his work cut out for him or are what you are saying he is clueless and delusional? Mission one is to deliver for the T1s. As I have said several times it will take 18 months for afrezza to become step 2 for the T2s. Knowing what we know, afrezza smokes the GLP-1s and has basically obsoleted the need for them. Now what doctor in their right mind would treat T2 diabetics with a basal when they have a prandial which has near zero chance of hypos when not used with other medications? The big question will be should metformin remain step 1 or should it be; lose a few pounds; take a walk; and take the afrezza with each meal? As Ralph DeFronzo told us last year - “The most waste in type 2 diabetes is to continuously put people on metformin and sulfonylureas (glyburide, glimepiride, etc.). These drugs have no protective effect on the beta cell, and by the time you figure out what you’re doing, there are no beta cells left to save.” – Dr. Ralph DeFronzo (University of Texas Health Science Center) diatribe.org/the-diatribe-foundation-and-tcoyd-11th-annual-forumNow if Dr DeFonzo sat on the ADA advisory committee I’d say we have ahead start.
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Post by mnkdfann on Jul 6, 2018 11:19:30 GMT -5
As Ralph DeFronzo told us last year - “The most waste in type 2 diabetes is to continuously put people on metformin and sulfonylureas (glyburide, glimepiride, etc.). These drugs have no protective effect on the beta cell, and by the time you figure out what you’re doing, there are no beta cells left to save.” – Dr. Ralph DeFronzo (University of Texas Health Science Center) diatribe.org/the-diatribe-foundation-and-tcoyd-11th-annual-forumNow if Dr DeFonzo sat on the ADA advisory committee I’d say we have ahead start. DeFronzo, AFAIK, wasn't promoting Afrezza. And, elsewhere, he has been big on promoting SGLT2. So I'm not sure him being on the ADA advisory committee would benefit Afrezza.
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Post by agedhippie on Jul 6, 2018 13:02:15 GMT -5
Aged - so what you are saying is Dr. Kendall has his work cut out for him or are what you are saying he is clueless and delusional? Mission one is to deliver for the T1s. As I have said several times it will take 18 months for afrezza to become step 2 for the T2s. Knowing what we know, afrezza smokes the GLP-1s and has basically obsoleted the need for them. Now what doctor in their right mind would treat T2 diabetics with a basal when they have a prandial which has near zero chance of hypos when not used with other medications? The big question will be should metformin remain step 1 or should it be; lose a few pounds; take a walk; and take the afrezza with each meal? As Ralph DeFronzo told us last year - “The most waste in type 2 diabetes is to continuously put people on metformin and sulfonylureas (glyburide, glimepiride, etc.). These drugs have no protective effect on the beta cell, and by the time you figure out what you’re doing, there are no beta cells left to save.” – Dr. Ralph DeFronzo (University of Texas Health Science Center) diatribe.org/the-diatribe-foundation-and-tcoyd-11th-annual-forumI think getting Afrezza added to the Standard of Care for Type 1 and Type 2 along side RAA should be trivial based on the non-inferiority data. Replacing RAA is not going to happen without a large scale trial to show superiority in HbA1c. Metformin remains step one, and if you want to hear the debate as to why it's in the ADA/EASD draft joint consensus statement (basically it's low risk, safe, and cheap). The follow up will be SGLT-2 and then GLP-1, after that basal, after that prandial. For my money the most interesting part of that webcast came at the very end of the Q&A session when a professor from Newcastle in the UK said that there were two trials ending by year end that would render the consensus statement redundant. Given that he was from Newcastle I would expect at least one of those to be the second year results from DIRECT which uses a very aggressive 12 week diet to restart the glucose metabolism. I am not sure exactly what form the results will take but he was certainly talking them up.
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