Is Inhaled Insulin A Viable Alternative For Patients With Diabetes?

By Jennifer Pahira and John S. Steinberg, DPM

What The Research Reveals

     Although inhalation directly into the lungs seems to be a promising new clinical approach for insulin delivery, there are some concerns regarding the long-term effects of growth protein inhalation on the lungs.      However, in a 2004 study conducted by Pfizer Global Research and Development, investigators noticed similar improvements in hemoglobin A1c levels and average changes in pulmonary function in separate patient groups taking inhaled or injected insulin. Overall, patients reported increased comfort and ease of use with inhaled insulin as compared to injection.      Another study reported in the Archives of Internal Medicine confirmed similar results in people with type 2 diabetes who took either a combination of short-acting inhaled insulin and long-acting injected insulin, or took injected insulin alone. Researchers concluded that the addition of one to two pre-meal inhalation doses improved glycemic control without the need for additional subcutaneous injections.2      As reported by the American Diabetes Association, events of mild hyperglycemia are lowered slightly among people who inhale insulin. A six-month trial done by Hollander, et. al., studied a group of men and women between the ages of 35 and 80 with type 2 diabetes who had a history of taking at least two insulin shots daily.3 One treatment group took inhaled insulin pre-meal along with one dose of long-acting injected insulin at bedtime and the other took two daily shots of injected insulin alone.      Confirming previous studies, investigators found lowered hemoglobin A1c levels in both patient groups. Additionally, hyperglycemia was slightly lower among inhaled insulin patients (1.4 events per patient per month) with no differences in severe episodes.3

Some Caveats You Should Keep In Mind

     The FDA has not approved Exubera for children or teens. Additionally, smokers are discouraged from using Exubera because more of the insulin is able to enter the body through the lungs and could cause an overdose. Interestingly, researchers found that smokers who utilized inhaled insulin had a higher systemic absorption while non-smokers who were exposed to secondhand smoke had a lower systemic absorption. Inhaled insulin may perform differently in other patients with pulmonary diseases such as asthma, bronchitis or chronic obstructive pulmonary disease. The known side effects at this time are coughing, shortness of breath, sore throat and dry mouth.      Exubera was expected to be widely available on the shelves of pharmacies in late summer of 2006. Early cost comparisons put the price of inhaled insulin at approximately three times that of traditional injected forms. Although pricing may be modified by Pfizer along the way, there is concern that this high cost could create some challenging coverage and formulary battles with health insurance plans, etc.

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