Inhaled Insulin Effective Adjunct to Glycemic Control

Use of bolus inhaled insulin along with subcutaneous basal insulin seems comparable to that of subcutaneous basal/bolus insulin in maintaining glycemic control in patients with type 1 diabetes and is equally well tolerated.

Lead investigator Dr. Jay S. Skyler stated that, "Inhaled insulin offers patients with diabetes the potential of avoiding pre-meal injections — without any loss of diabetes control. This can improve their quality of life."

Dr. Skyler of the University of Miami and colleagues note that patient acceptance of basal and bolus insulin therapy has been slow, despite offering sound glycemic control. To investigate whether such an approach employing inhaled insulin would be effective, the researchers studied 328 patients with type 1 diabetes.

They received twice daily subcutaneous injections of NPH insulin and were randomized also to have premeal inhaled insulin or premeal subcutaneous insulin for a 6-month period.

A similar proportion of patients in the inhaled group (23.3%) and the subcutaneous group (22.0%) achieved an HbA1c of less than 7.0%. Postprandial glucose reductions were comparable between groups, but there was a greater reduction in fasting plasma glucose levels in the inhaled group.

The rate of hypoglycemia was 9.3 episodes per patient-month in the inhaled group and 9.9 in the subcutaneous group. However, the rate of severe episodes was greater in the inhaled group.

Both group experienced a similar weight gain of about 1.4 kg and insulin use in both groups increased slightly over the study period. Lung function was also comparable between the two groups.

Given these findings, the researchers conclude that "inhaled insulin may provide an alternative to subcutaneous insulin … as part of a basal/bolus strategy in patients who are unwilling or unable to use preprandial insulin injections."
Diabetes Care 2005;28:1630-1635.

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FACT:

Non–HDL-C and the ratio of total cholesterol to HDL-C were as good as or better than apolipoprotein fractions in the prediction of future cardiovascular events. After adjustment for age, blood pressure, smoking, diabetes, and obesity, high-sensitivity CRP added prognostic information beyond that conveyed by all lipid measures. JAMA. 2005;294:326-333.

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