Inhaled Insulin Improves Glycemic Control In Patients With Type 2 Diabetes Mellitus

Abstract

Source: Weiss SR, Cheng SL, Kourides IA, et al. Inhaled insulin provides improved glycemic control in patients with type 2 diabetes mellitus inadequately controlled with oral agents. Arch Intern Med. 2003;163:2277–2282.Administration of subcutaneous insulin can be initially quite daunting for many diabetes mellitus (DM) patients. Investigators from San Diego Endocrine and Medical Clinic, San Diego, Calif., Pfizer Global Research and Development, New London, Conn., and Yale University School of Medicine, New Haven, Conn., studied 69 patients with type 2 DM, between the ages of 35 and 65 years, who were on oral hypoglycemic agents (OHA) and whose HbAlC levels were between 8 and 12%. They randomized patients to an open label treatment with preprandial inhaled insulin plus OHA versus OHA alone, and followed them weekly, titrating to a 2-hour post-prandial increase in glucose level of <60mg/dL. Both the treatment and control groups had an average HbAlC at the start of the trial of around 10%. At the end of the trial, the pa­tients in the control group still had an average HbAlC of 10%, whereas the patients in the treatment group had an average of 7.5% at the end of the 12-week trial. Seventeen percent of the patients in the control group had a hypoglycemic event compared to 69% of the patients in the treatment group. Those in the treatment group also had improvement in post-prandial blood sugar measurements and in their fasting lipid panels. Pulmonary function tests were unchanged in either group.The Diabetes Control and Complications Trial Research Group1 showed that tight and intensive treatment of blood sugar levels in patients with type 1 DM reduces microvascular complications of retinopathy and nephropathy. Attaining that control comes at the cost of increasing symptomatic hypoglycemic episodes. The authors of this study test whether inhaled insulin can benefit patients with type 2 DM who are not optimally controlled. Their results show that this mode of delivery can indeed be as effective as subcutaneous injection in this population. The increase in hypoglycemic events with insulin therapy comes as no surprise. Clearly, this study in adults would require follow-up in a pediatric population to determine if inhaled insulin can be as effective in children with type 1 and type 2 DM, and if long-term administration has any ill effects. Faced with an increasing rate of obesity and type 2 DM in adolescents, such a study may be worthwhile.