How to Use Inhaled Insulin

News from Diabetes Care 2006 6;29(6):1282-7

This was an open-label, multicenter study of people with T2DM with A1cs above 8% who had been treated for 2 months with a maximal dose of a sulfonylurea which was continued at that dose throughout the trial.

Before randomization they were divided into two arms of A1c of 8-9.5% (moderately high) or 9.5-12% (very high). The addition of inhaled insulin demonstrated improved glycemic control as compared to metformin in the “very high” arm but was comparable to adding metformin in the “moderately high” arm and in the overall cohort.

An A1c below 8% was attained by 64% in the inhaled insulin and 58% in the metformin group. 25% of the inhaled insulin and 23% of the metformin group achieved an A1c below 7%. Weight gain was 3 kg with the addition of inhaled insulin with a mean decrease of 0.1 kg with metformin. No statistically significant changes occurred in the lipid parameters in either group.

Hypoglycemia occurred in 114 in the inhaled insulin (73 mild, 36 moderate, and 3 severe) and 54 in the metformin group (41 mild and 12 moderate). The rates of overall hypoglycemia (events/subject-month) were 0.31 for inhaled insulin vs. 0.17 for metformin. Increased cough was reported by 9.0% (20/222) in the inhaled insulin and 1.5% (3/201) in the metformin group. No patients discontinued due to hypoglycemia or cough.

The fact that A1cs improved more with the addition of insulin in the “very high” group is not a surprise. What is surprising is that with an average duration of known diabetes of about 8 years there was so much of a response to the addition of metformin. These data do not suggest that inhaled insulin should replace metformin in our approach to treatment but that perhaps we should consider using it early in people with high A1cs.

I am starting to use it now.