Evaluation of inhaled insulin therapy for diabetes mellitus.

ABSTRACT

Inhaled insulin (INH) is a novel, non-injectable alternative route of delivery of insulin for the management of diabetes mellitus (DM). It is an important breakthrough in the history of diabetes mellitus and an attractive means of treatment for many patients. Though insulin is one of the fundamental tools for management of DM, many patients and physicians are reluctant to initiate and intensify the insulin regime in appropriate time due to various reasons called psychological insulin resistance (PIR). Exubera, one of the inhaled insulin devices has been approved by FDA and European Union in early 2006. It delivers short acting human insulin powder in aerosol form. There are lot of ongoing studies regarding the efficacy and safety of INH. Inhaled insulin showed similar pharmacokinetic and glucodynamic behavior like that of subcutaneously administered rapid acting human insulin analogues like aspart, lispro and glulisine. It consistently improves glycemic control when used in combination with longer acting subcutaneous insulin regime in patient with type 1 and type 2 DM. It may be used to replace or supplement oral antidiabetic therapy in type 2 diabetic patients. Available study reports showed its tolerability and safety with an overall similar risk of hypoglycemia to that of subcutaneous insulin. So far, no significant clinically meaningful pulmonary functional changes have been noted with the use of INH. Various reports showed high level of patients satisfaction and an acceptable new modality of non-invasive treatment. However, long term follow up studies are needed to evaluate the safety profiles of inhaled insulin.