Will Doctors educate patients on needles or give them an inhaler?

A Response to The Curious And Complicated Case Of MannKind on Investopedia

Not All Good News, ThoughUnfortunately, Afrezza is not the slam-dunk its supporters want it to be. None of the clinical trials done to date have shown any superiority in efficacy (as measured by HbA1c) for inhaled insulin. In fact, every trial I have seen has shown a slight underperformance for Afrezza - not enough to be statistically significant or technically inferior, but enough to suggest that Afrezza is not demonstrably better at maintaining long-term glucose control. Moreover, I fear that some investors may overstate the benefits of an inhaled insulin delivery system. It is true that there is substantial needle-fear in patients who are starting insulin therapy, but that fear disappears. As part of my consulting work, I have seen several surveys of diabetics (covering thousands of respondents) and there is a remarkable and consistent curve - those who have never injected are very bothered by the idea, but that fear and anxiety declines rapidly once they begin therapy and become accustomed to it. Consequently, there may not be as much commercial demand for the product as people think - particularly if doctors spend time with patients to ease their anxieties about injections.

It almost doesn't matter whether diabetic patients are afraid of needles or not.  If they are afraid, the doctor has a choice--have a long conversation on needles and the fact that the patient need not fear or simply give them a prescription for an inhaler from Mannkind.  Everyone understands inhalers...everyone has seen asthmatics using them....no fear, no discussion (assuming all else is equal).

For current needle using diabetics, life has gotten much easier with the pens that are available on the market.  They can carry them in a pocket and go to the bathroom to give themselves a shot.  With the inhaler form-factor, they no longer need to go to the bathroom to give themselves a shot...and if they do it in public, than, the form-factor itself provides no big advantages.

However, all else is not equal.  Afrezza has a faster response time compared to any inject-able insulin which reduces all kinds of risk for patients.  Thus, I would imagine doctors, once exposed to Afrezza would consider having a conversation with existing needle users (who are comfortable with needles) about Afrezza especially if those patients have trouble controlling their insulin levels...

Disclaimer: I am long on Mannkind.