Inhaled Insulin Improves Glycemic Control When Substituted for or Added to Oral Combination Therapy in Type 2 Diabetes

Rosenstock, Julio; Zinman, Bernard; Murphy, Liam; Clement, Stephen; Moore, Paul A.; Bowering, C. Keith; Hendler, Rosa; Lan, Shu-Ping; Cefalu, William T.

doi:10.7326/0003-4819-143-8-200510180-00005

Cited by 152 publications

(112 citation statements)

References 34 publications

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“…To date, these questions have not been answered adequately. Some recently published clinical trials have demonstrated greater efficacy of inhaled insulin in achieving glycemic control than traditional therapy in both type 1 and type 2 diabetes, without significant differences in major functional lung indices between the group treated with inhaled insulin and that treated with subcutaneous administration of insulin [99,100,103,104]. However, the follow-up in these studies was between 3 and 6 months, probably too short to detect possible differences between the groups.…”

Section: Potential Effects Of Inhaled Insulin On the Respiratory Tractmentioning

confidence: 97%

The Diabetic Lung - A New Target Organ?

Pitocco

Fuso²,

Conte³

et al. 2012

Rev Diabet Stud

134

112

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■ AbstractSeveral abnormalities of the respiratory function have been reported in patients with type 1 and type 2 diabetes. These abnormalities concern lung volume, pulmonary diffusing capacity, control of ventilation, bronchomotor tone, and neuroadrenergic bronchial innervation. Many hypotheses have emerged, and characteristic histological changes have been described in the "diabetic lung", which could explain this abnormal respiratory function. Given the specific abnormalities in diabetic patients, the lung could thus be considered as a target organ in diabetes. Although the practical implications of these functional changes are mild, the presence of an associated acute or chronic pulmonary and/or cardiac disease could determine severe respiratory derangements in diabetic patients. Another clinical consequence of the pulmonary involvement in diabetes is the accelerated decline in respiratory function. The rate of decline in respiratory function in diabetics has been found to be two-to-three times faster than in normal non-smoking subjects, as reported in longitudinal studies. This finding, together with the presence of anatomical and biological changes similar to those described in the aging lung, indicates that the "diabetic lung" could even be considered a model of accelerated aging. This review describes and analyses the current insight into the relationship of diabetes and lung disease, and suggests intensifying research into the lung as a possible target organ in diabetes.

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Section: Potential Effects Of Inhaled Insulin On the Respiratory Tractmentioning

confidence: 97%

The Diabetic Lung - A New Target Organ?

Pitocco

Fuso²,

Conte³

et al. 2012

Rev Diabet Stud

134

112

View full text Add to dashboard Cite

show abstract

“…Recently, a series of multicenter trials of inhaled human insulin (Exubera [insulin human (rDNA origin)] Inhalation Powder; Pfizer, Inc., New York, NY; and Nektar Therapeutics, San Carlos, CA) was completed in individuals with type 1 and 2 diabetes (13)(14)(15)(16)(17)(18)(19)(20)(21)(22). Serial DL CO measurements were obtained in participants receiving inhaled insulin and in comparator participants receiving no inhaled therapy.…”

mentioning

confidence: 99%

Intersession Variability in Single-Breath Diffusing Capacity in Diabetics without Overt Lung Disease

Drummond¹,

Schwartz²,

Duggan³

et al. 2008

Am J Respir Crit Care Med

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Rationale: American Thoracic Society guidelines state that a 10% or greater intersession change in diffusing capacity of the lung (DL CO ) should be considered clinically significant. However, little is known about the short-term intersession variability in DL CO in untrained subjects or how variability is affected by rigorous external quality control. Objectives: To characterize the intersession variability of DL CO and the effect of different quality control methods in untrained individuals without significant lung disease. Methods: Data were pooled from the comparator arms of 14 preregistration trials of inhaled insulin that included nonsmoking diabetic patients without significant lung disease. A total of 699 participants performed repeated DL CO measurements using a highly standardized technique. A total of 948 participants performed repeated measurements using routine clinical testing. Measurements and Main Results:The mean intersession absolute change in DL CO using the highly standardized method was 1.45 ml/ minute/mm Hg (5.64%) compared with 2.49 ml/minute/mm Hg (9.52%) in the routine testing group (P , 0.0001 for both absolute and percent difference). The variability in absolute intersession change in DL CO increased with increasing baseline DL CO values, whereas the absolute percentage of intersession change was stable across baseline values. Depending on the method, 15.5 to 35.5% of participants had an intersession change of 10% or greater. A 20% or greater threshold would reduce this percentage of patients to 1 to 10%. Conclusions: Intersession variability in DL CO measurement is dependent on the method of testing used and baseline DL CO . Using a more liberal threshold to define meaningful intersession change may reduce the misclassification of normal variation as abnormal change.

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“…In a study comparing Technosphere® insulin to Technosphere® placebo in insulin-naïve T2 subjects, there was no increase in hypoglycemic events/month in those receiving inhaled insulin [41]. Hypoglycemia rates were higher in individuals with T2D treated with inhaled insulin either alone or in combination with two oral agents compared to those treated with oral agents alone [40]. In a study of subjects with poorly controlled T2D on two oral agents, the incidence of hypoglycemia was comparable between inhaled AIR® insulin and lispro insulin [39].…”

Section: Safety Of Inhaled Insulinmentioning

confidence: 99%

“…In a similar population, the addition of either prandial AIR® inhaled insulin or insulin lispro to oral therapy resulted in comparable reductions in HbA1c after 6 months of therapy [39]. When Exubera® was substituted for or added to dual oral therapy in a cohort of T2D patients with HbA1c >8%, the change in HbA1c from baseline was significantly lower for those subjects receiving inhaled insulin vs. those receiving oral therapy alone [40]. While the combination of oral therapy and Exubera® led to the highest percentage of subjects achieving HbA1c <7% (32%), more subjects reached target HbA1c with inhaled insulin alone compared to dual oral therapy (16.7% vs. 1%).…”

Section: Type 2 Diabetesmentioning

confidence: 99%

Managing diabetes with inhaled insulin

Mastrandrea

2012

RHC

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The incidence of diabetes is increasing world-wide. Many individuals with diabetes require insulin to control their blood sugar and prevent both microvascular and macrovascular complications associated with this chronic disease. Current regimens involve delivery of subcutaneous insulin by injection or continuous insulin infusion. One area of research to advance diabetes care is aimed at developing alternate routes of insulin administration that will make daily management less invasive for patients. This review will focus on inhaled insulin, a novel formulation which takes advantage of drug delivery through the pulmonary system. The pharmacology, efficacy, and safety of inhaled insulin will be discussed. In addition, the status of inhaled insulin as a potential therapy for individuals with diabetes will be reviewed.

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Inhaled Insulin Improves Glycemic Control When Substituted for or Added to Oral Combination Therapy in Type 2 Diabetes

Cited by 152 publications

References 34 publications

The Diabetic Lung - A New Target Organ?

The Diabetic Lung - A New Target Organ?

Intersession Variability in Single-Breath Diffusing Capacity in Diabetics without Overt Lung Disease

Managing diabetes with inhaled insulin

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