Point: Pulmonary Inhalation of Insulin: Another “Brick in the Wall”

Abstract

The latest innovation for advancing diabetes care is not a new pharmacologic class; it represents a new “twist” on one of the oldest pharmacologic agents known for treatment of diabetes. After >80 years of clinical use and after many years of research for alternative means of delivery (including dermal, nasal, and oral approaches), insulin delivered by pulmonary inhalation is finally a clinical reality. The availability of inhaled insulin could not have come at a better time. At a time when the prevalence of diabetes is increasing at alarming rates worldwide and when the majority of individuals with diabetes have not achieved the recommended glycemic goal, new insights into the disease itself are being revealed at a rapid pace and are allowing for the development of novel approaches to better manage the disease. As such, inhaled insulin now joins the glucagon-like peptide 1 (GLP-1) agonists, dipeptidyl peptidase-IV inhibitors, and synthetic analogs of amylin as the latest tools available to the clinician. However, it is somewhat surprising that despite the promise that inhaled insulin could contribute to a paradigm shift in the clinical management of diabetes, considerable concern is openly expressed regarding its routine use. There is no question about the need for insulin therapy in an individual with type 1 diabetes. The use of insulin in type 2 diabetes and, in particular, earlier in the course of management is supported by the natural history of the disease, which is characterized by progressive β-cell dysfunction. However, as a medical community, we need to do a much better job in advancing therapy in order to achieve glycemic control. Data from the National Health and Nutrition Examination Survey (NHANES) III and NHANES 1999–2000 suggested, if anything, a decrease in the percentage of individuals achieving glycemic targets (1). At the same time, the percentage of …