Inhaled, dry powder insulin

Diabetes mellitus (DM) currently affects an estimated 20.8 million people within the United States, with a current worldwide prevalence estimated at 180 million and which is expected to double by 2030. Despite the many advances in the management of both type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM) in recent years, the average glycated hemo globin test (HbA1c) result of patients with diabetes increased from 7.7% to 7.9% between 1990 and 1999. Strong evidence exists demonstrating the benefits of tight glycemic control in T1DM and T2DM patients; however, glycemic goals are not adequately achieved for many patients. While people with T1DM require insulin, many T2DM patients could improve their glycemic control by the initiation of insulin therapy, but they are either not prescribed insulin or have fear associated with the injection process. The advent of dry powdered insulin delivered by pulmonary inhalation provides an alternative mode of delivery for patients with perceived barriers to the use of insulin. One clinical trial looked at the acceptance of insulin therapy in 700 participants with T2DM and an HbA1c result greater than 8%. The subjects in this study were randomized to receive information regarding the risks and benefits of various treatment options. A treatment regimen that included insulin was opted for by 43.2% of patients in the group that had received information on inhaled, dry powder insulin (IDPI), compared with 15.5% of those offered information only on subcutaneous (SC)insulin therapy. Results from this trial suggest that availability of inhaled insulin may increase acceptance of insulin therapy in patients not currently using insulin. This review will discuss the clinical pharmacology, tolerability, contraindications and precautions, side effects, and special considerations of the currently marketed IDPI product Exubera.