Inhaled insulin is a new option for type 2 diabetic patients with poor glycemic control on oral monotherapy.
A rapid-acting inhaled insulin (Exubera) was approved recently for treatment of type 1 and type 2 diabetes and is expected to be available soon. Several studies have shown that it compares favorably with oral agents in patients with type 2 diabetes, albeit with increased risk for hypoglycemia.
This industry-sponsored trial involved 427 patients whose type 2 diabetes was controlled poorly (glycosylated hemoglobin [HbA1c] level, 8%–12%) by sulfonylurea drugs. Patients were randomized to add-on therapy with either inhaled insulin (3 times daily before meals, with dose titration) or metformin (target dose, 1 g twice daily). During 24 weeks of treatment, HbA1c levels decreased by 2.1% in the inhaled-insulin group and by 1.9% in the metformin group — a small but statistically significant difference. Patients with baseline HbA1c levels higher than 9.5% accounted for most of the difference between groups. Hypoglycemic events were more common among insulin recipients than among metformin recipients (0.31 vs. 0.17 events per patient per month), and insulin recipients gained an average of 3 kg (vs. no significant weight change in the metformin group).
Inhaled insulin is a new option for type 2 diabetic patients with poor glycemic control on oral monotherapy. As with other insulins, inhaled insulin is associated with hypoglycemia and weight gain. Small changes in pulmonary function also have been noted among users of inhaled insulin; whether these changes are important during long-term therapy is unclear.
Reference:
Barnett AH et al. An open, randomized, parallel-group study to compare the efficacy and safety profile of inhaled human insulin (Exubera) with metformin as adjunctive therapy in patients with type 2 diabetes poorly controlled on a sulfonylurea. Diabetes Care 2006 Jun; 29:1282-7.