Author: de Galan, Bastiaan E

Source: Expert Review of Pharmacoeconomics and Outcomes Research, Volume 8, Number 1, February 2008 , pp. 33-42(10)

Publisher: Expert Reviews

Abstract:

Reluctance to start and adequately titrate subcutaneous insulin are major reasons why many patients with diabetes mellitus are insufficiently metabolically controlled. Pulmonary insulin administration has the advantage over subcutaneous insulin in that it is noninvasive, seems better accepted by the diabetic population and exerts equal efficacy in terms of glycemic control. As such, inhaled insulin has the potential to increase the diabetic (Type 2) patients willingness to commence and adhere to insulin therapy. Inhaled insulins short duration of action makes it suitable for prandial administration provided that basal insulin requirements are met by residual b-cell function, or by supplemental long-acting subcutaneous insulin. In clinical trials, inhaled insulin is comparable to short-acting subcutaneous insulin with regard to efficacy and hypoglycemic risk. Adverse effects associated with inhaled insulin include dry cough, which tends to diminish over time, a slight drop in pulmonary function that does not progress and is reversible in most patients if treatment is discontinued, and increased insulin antibody formation, albeit without clinical sequelae. Long-term safety remains an issue for a product intended to be used chronically for many years. Exubera was thus far the only inhaled insulin product to receive approval in the USA and Europe for use in adults with Type 1 or Type 2 diabetes, but was recently withdrawn from the market. At present it is unclear how this decision will affect programs from other companies with inhaled insulin products under development.

Keywords: anti-insulin antibodies; body weight; diabetes mellitus; glycemic control; hypoglycemia; inhaled insulin; pulmonary function

Document Type: Research article

DOI: http://dx.doi.org/10.1586/14737167.8.1.33

Affiliations: 1: The George Institute for International Health, Level 10, King George V Building, Royal Prince Alfred Hospital, Missenden Road, Camperdown, Sydney NSW 2050, Australia; Department of Internal Medicine, Radboud University Nijmegen Medical Centre, PO

Publication date: 2008-02-01

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• Expert Review of Pharmacoeconomics & Outcomes Research provides expert commentary on cost-benefit and pharmacoeconomic issues relating to the clinical use of drugs and therapeutic approaches. Coverage includes pharmacoeconomics and quality-of-life research, therapeutic outcomes, evidence-based medicine and cost-benefit research.
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