Whole Exubera story at: medscape.com
INDEX of Sections:
Abstract and Introduction
Peptide Delivery: Inhalation Route
Insulin Delivery Devices
Pharmacology
Clinical Efficacy
Long-term Efficacy
Smoking and Inhaled Insulin
Adverse Events
Patient Satisfaction and Acceptability
Cost of Treatment
Conclusions
First of 11 sections:
Inhaled Insulin: Overcoming Barriers to Insulin Therapy?
Posted 10/06/2006
Srikanth Bellary; Anthony H Barnett
Abstract and Introduction
Abstract
Inhaled insulin is a new route of insulin delivery that can be used in the treatment of type 1 and type 2 diabetes. It offers an alternative and additional means of insulin administration, and has been received with particular satisfaction by patients who dislike injections. Trials indicate that inhaled insulin can be used effectively for pre-meal bolus intensification of treatment. Pre-meal inhaled insulin with Exubera® has shown faster absorption and similar duration of action to regular subcutaneous insulin with an overall similar glucodynamic effect. Although bioavailability is lower, mainly due to losses in the upper airways, this is compensated for by dose. The commonest side effect reported with inhaled insulin, as with subcutaneous insulin, was hypoglycaemia, almost a quarter of patients noted a cough which settled with continued treatment. Increased antibody titres and changes in lung function return to normal on discontinuation of inhaled insulin. Quality of life scores indicate patient preference for inhaled versus injected insulin, thus increased choice may improve adherence to treatment regimens. However, true cost:benefit analyses have to be undertaken as do studies in children, smokers and people with respiratory conditions, e.g. asthma.
Introduction
Despite the recognition that tight glycaemic control is central to the prevention of micro and macrovascular complications,[1-3] it is difficult to achieve or maintain.[4] Changing needs of patients, poor compliance, limitations of existing treatments, and the progressive nature of diabetes itself can all contribute to this. There is therefore much interest in new therapies. Intensive treatment with insulin has been shown to have significant benefits in both type 1 and type 2 patients with diabetes.[5] Dislike for needles and patient anxiety related to insulin injections, however, remain major barriers to insulin initiation or intensification of insulin treatment.[6-8] Availability of non-invasive insulin may help overcome some of these problems and may encourage compliance with treatment and in turn improve long-term control. Inhaled insulin (Exubera®) is the latest addition to the list of new therapies in the management of diabetes and may be a viable alternative to sc insulin. It has been granted license in the United States and Europe and will be available for clinical use soon. |
