This isn’t pretty

This isn’t pretty

Yesterday shares of MannKind (NASDAQ: MNKD) hit an all-time low of $1.64 before closing at $1.67. On a year to date basis shares have fallen over 68%.  Now we could take a moment and gloat just a little but we won’t. While the MannKind Afrezza zealots on Twitter seem to think we enjoy watching investors loss their hard earned money, we don’t. We do not however have much sympathy for MannKind investors as quite frankly they are getting what they deserve.

The other day a respected diabetes researcher reached out to Diabetic Investor stating that he has seen results for Type 1’s using Afrezza and they were quite good. That these experienced insulin users were using Afrezza to smooth out their glucose patterns. These results didn’t surprise Diabetic Investor as we have heard this from other experienced insulin users. Many of these patients have been using insulin for years and understand the importance of tight glycemic control.

The only problem is experienced Type 1’s were not Afrezza’s target market, insulin using Type 2’s was supposed to be the target. This is just another reason so many investors got burned and while so many of the MannKind/Afrezza zealots keep believing. No one has ever stated that Afrezza does not work, that it is an inferior insulin. This has never been the problem; the problem is the people who were supposed to be using the product aren’t using it.

This is why we have always maintained that Afrezza would be nothing more than niche product. That besides the many other issues facing the drug there is a finite group of Type 1 patients who keep their glucose levels in a tight range. Frankly this is the same problem faced by insulin pump or continuous glucose monitoring companies. There is a boatload of evidence that shows the effectiveness of insulin pump therapy. There is a growing body of evidence that shows how CGM helps improve outcomes.

Yet even with all this evidence insulin pump usage is barely growing and CGM usage will at some point plateau. What most people don’t understand that the “best” therapy regimen doesn’t always win in the marketplace. That it’s people not machines that make the decision on which therapy option to follow.

Sure in theory inhaled insulin makes sense that is of course until you put inhaled insulin in a real world setting. The reality is most non-diabetics no matter how hard they try cannot grasp the amount of work that goes into managing diabetes. They think that just because a patient can avoid multiple injections each and every day they will flock to a product like Afrezza. The reality is Afrezza requires more not less knowledge of managing diabetes which is why experienced Type 1 patients use it and insulin using Type 2’s don’t.

This fact should have not gone unnoticed by MannKind’s partner Sanofi (NYSE: SNY) yet like so many others they fell for the hype. Come early next year we’ll find out if they have learned their lesson. The MannKind story isn’t over yet but the end is coming.