Inhaled Insulin Effective Therapy for Poorly Controlled Type 2 Diabetes

Inhaled human insulin (Exubera) is as effective as glibenclamide as adjunctive therapy in patients with type 2 diabetes. Dr. Anthony H. Barnett from the University of Birmingham, UK and colleagues compared the glycemic control obtained with inhaled insulin with that achieved with the sulfonylurea glibenclamide (glyburide) in 456 patients with type 2 diabetes poorly controlled by metformin monotherapy.

Overall, inhaled human insulin and glibenclamide provided similar improvements in glycemic control in these patients, the authors report, averaging reductions in hemoglobin A1c of 2.03 and 1.88 percentage points, respectively.

Among patients with the highest A1c levels (above 9.5%), inhaled human insulin provided glycemic control superior to that provided by glibenclamide, the results indicate.

Both treatments provided similar improvements in fasting plasma glucose and 2-hour postprandial glucose, the researchers note.
Treatment with inhaled human insulin was associated with a higher frequency of increased cough and a higher incidence of hypoglycemic episodes, the report indicates, but there were no severe events and no discontinuations due to hypoglycemia.
"The results of this study demonstrate that adding inhaled human insulin or glibenclamide to patients poorly controlled on metformin was similarly effective in improving glycemic control," Dr. Barnett and colleagues conclude.

They suggest that "inhaled human insulin in combination with metformin therapy should be considered a viable alternative to the addition of a second oral agent in patients with high A1c levels failing to achieve satisfactory glycemic control with metformin alone."

Diabetes Care 2006;29:1818-1825.

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