In 38 million people living with diabetes rely on daily injections or insulin pumps to maintain safe glucose levels. However, recent research suggests there may be a viable alternative. Led by Dr. Irl B. Hirsch, M.D., medical director of the Diabetes Care Center at the University of Washington Medical Center, a study presented at the American Diabetes Association’s 84th Scientific Sessions in Orlando, Florida, showcased promising results for an inhaled form of insulin as a comparable option to injections and pumps in managing type 1 diabetes.
The clinical trial focused on Afrezza, an inhaled insulin product developed by MannKind Corporation in California and approved by the FDA in June 2014. Unlike traditional injections or pumps, Afrezza offers a convenient method akin to using an asthma inhaler. It delivers fast-acting insulin directly into the lungs before meals, effectively minimizing the glucose spikes often experienced after eating.
Dr. Hirsch emphasized the significance of Afrezza’s role as a potential third option for diabetes management. While insulin remains critical for survival in type 1 diabetes, not all patients achieve optimal glucose control with current methods. Insulin pumps, though beneficial, come with challenges such as skin issues and the need for additional accessories. On the other hand, injections, while widely used, may not offer the same level of control as pumps for some individuals.
During the 17-week study involving 141 adults, participants either used the Afrezza inhaler or continued with their conventional injection or pump therapies. Subsequently, all groups switched to Afrezza for an additional 13 weeks. Continuous glucose monitoring throughout the study period revealed that 30% of those using Afrezza achieved their target glucose levels (less than 7% blood sugar), compared to 17% of those using injections or pumps. Importantly, there was no significant difference in the occurrence of hypoglycemia (low blood sugar) between the groups.
The study underscored that while the average blood sugar levels (HbA1c) did not differ significantly across groups, individual responses varied. Some participants demonstrated improved glucose control with Afrezza, especially when using the inhaler between meals and at bedtime.
Patient feedback was positive, with more than half of the participants expressing a preference to continue using Afrezza after the study’s conclusion. This underscores the potential value of inhaled insulin as an additional therapeutic option, particularly for mealtime insulin needs.
The American Diabetes Association acknowledged the study’s findings as promising, noting the potential of alternative insulin delivery methods to expand diabetes care options. Dr. Raveendhara Bannuru, M.D., PhD, the ADA’s vice president of medical affairs and quality improvement outcomes, highlighted the trial’s role in enhancing diabetes management through innovative therapies.
Despite its benefits, Afrezza may not be suitable for everyone. Some participants experienced worse glucose readings with Afrezza, possibly due to inconsistencies in dosing times or amounts. Common side effects included hypoglycemia, coughing, and throat irritation, although major safety concerns were minimal.
Before starting Afrezza, patients are advised to undergo a thorough physical examination and lung function testing, particularly those with chronic lung conditions like asthma or COPD. Smokers or recent ex-smokers are cautioned against using inhaled insulin due to potential risks.
Injections and pumps remain primary methods for managing diabetes, the introduction of inhaled insulin offers a promising alternative. Afrezza’s efficacy in controlling glucose levels, coupled with its ease of use, marks a significant advancement in diabetes treatment options. Patients with type 1 diabetes are encouraged to discuss the suitability of Afrezza with their healthcare providers to determine if it aligns with their individual treatment goals and preferences.
