Saturday, February 07, 2015

Why I Won't Be Recommending Afrezza

Inhaled insulin is once again on the market, but I have four good reasons not to use it. Here they are:

-Dosing is in increments of 4 units. So for your breakfast insulin, you can take 4 units, 8 units, 12 units, 16 units, 20 units, or 24 units. Or none. And for corrections, you have the same options. I'm sorry, 4 units is way too big of an increment. I like to be able to treat highs of 220 when I go to bed, and 4 units would be overkill (big overkill).

-No clinical trials were done with diabetics whose A1cs were below 7. When enrolling patients for trials, Afrezza was tried only in diabetics with A1cs above 7% (and below 10%). Afrezza was compared to using an inhaler that didn't contain a medication (in T2s) and to injected Novolog (in T1s). 6 months later, 27% of Novolog users got A1cs at or below 7% - twice as many as with Afrezza (13% got down there on Afrezza). Additionally, the average drop in A1c over the six months was 0.40% on Novolog vs 0.19% on Afrezza, which is statistically significant.
I'm not sure how much of this difference is because Novolog can be dosed in smaller increments.

-Afrezza has a significant risk of causing reduction in lung function. I like my lungs. Admittedly, it probably doesn't cause lipodystrophy, and it might be a reasonable choice for people with severe lipodystrophy and fairly high insulin needs.

-Although I have not seen any proof of what Afrezza will cost, estimates put it in the neighborhood of $100-$200/month without insurance. The discount card makes it cost $30/month with non-governmental insurance. I pay $24.88 per vial of Regular.

No comments: