DOCTOR'S VIEW ARCHIVE
Diabetes Update #6 Day 2, Saturday June 11 from the American Diabetes Association National Meeting
Diabetes Conference - Future of Inhaled Insulin
Dr. Ruchi Mathur offers perspectives of interest on topics from the American Diabetes Association's 65th Annual Scientific Sessions (held in San Diego, California June 10-14, 2005)
This is Dr. Ruchi Mathur, here at the 65th Scientific Sessions of the American Diabetes Association. This update will focus on pulmonary (inhaled) insulin and what we can expect in the near future.
The concept of using the lungs as a route for the delivery of insulin is certainly nothing new. As a matter of fact- the first paper on this topic was published in 1925! However, only recently has the technology advanced enough to make this option a real possibility.
There are a number of companies out there focused on the development of inhaled insulin . These include Pfizer, Lilly, MannKind Corporation, Aerogen, Kos and Novartis. Some of these insulins are being developed in a powder form, others are aerosolized.
When compared to the standard injection route of delivery of the short acting insulin lispro (Humalog T), studies have shown that inhaled insulin enters the blood stream faster and lasts a bit longer. Regarding the effectiveness- when dose matched, A1c values dropped to a similar degree in those receiving inhaled insulin as those on subcutaneous injections. This was seen in both patients with type 1 and type 2 diabetes - and when reviewed, the researchers found that inhaled insulin was associated with less weight gain then injected insulin. The data presented goes out to 4 years and shows a sustained benefit.
Regarding safety data, the original concerns were that either the inhaled insulin would affect the lungs or that underlying lung disease would affect the absorption of the insulin. Inhaled insulin is not to be used in people with chronic lung diseases. However, for study purposes, when given to patients with asthma, pulmonary function tests did not acutely deteriorate from baseline. In those with normal lung function, there was no chance in pulmonary function testing immediately after use, or over the long term. The other concern raised was regarding the development of antibodies to the insulin. This is true, particularly in patients with type 1 diabetes . However, the development of insulin antibodies did not seem to be clinically significant as patients did not require dose increases of insulin beyond those without antibodies, and A1c values did not change between these groups.
So, what does this mean? After almost 80 years, the concept of inhaled insulin is very close to reality. The side effects particularly on the lungs seem less worrisome then previously thought. And, based on the new data presented here at the ADA (American Diabetes Association), the effectiveness is comparable to injected short acting insulin. You will likely be hearing a lot more about inhaled insulin over the next year as it comes before the FDA for approval. Read and hear the next installment from the conference.
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