Issue 180 Item 8 Inhaled Insulin Good Option for Some Diabetics

The addition of inhaled insulin before meals improves control of blood glucose in patients with type 2 diabetes who are not adequately controlled by oral diabetes drugs.

Dr. Stuart R. Weiss, of the San Diego Endocrine and Medical Clinic, and other members of the Inhaled Insulin Phase II Study Group enrolled 68 patients with inadequately controlled disease. All patients were being treated with oral diabetes drug at maximum or near maximum doses.

Thirty-two patients were randomly assigned to receive inhaled insulin in addition to their regular oral diabetes therapy, and 36 patients received oral diabetes therapy alone. Inhaled insulin, averaging about 13 mg daily, was administered immediately before meals using a dry power aerosol delivery system (Nektar Therapeutics, San Carlos, California; Pfizer Inc., New York; Aventis, Bridgewater, New Jersey).

After 12 weeks, glycosylated hemoglobin levels, a measure of glucose control, significantly improved in the combination group, but not in the oral diabetes drug group. Improvements in fasting plasma glucose were also significantly better in the combination group. The authors also observed a greater decline in fasting serum triglycerides in the combination compared with the other group.

On the down side, the patients in the combination group gained more weight than the patients in the oral diabetes drug group did.
There were also 57 episodes of low blood glucose in the combination group, compared with only six such events in the other group. However, only one of these episodes was considered to be severe in the inhaled insulin group.

According to the authors, this rate is similar to that observed in patients using oral diabetes therapy plus injected insulin.
Weiss’ team further noted a high rate of patient satisfaction with inhaled insulin treatment, with 97% of those in the combination group choosing to continue in a one-year extension of the therapy.

Archives of Internal Medicine, October 27, 2003

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