Reporting in this week's American Diabetes Association meeting and in The Lancet, researchers compared two approaches to managing type 2 diabetes among patients ages 18 to 80 from 10 different countries. The patients were nonsmokers and had poor control of blood sugar despite insulin therapy.
A total of 211 patients received inhaled insulin plus insulin glargine, a long-lasting form of insulin taken by injection, before bedtime to help manage blood sugar. They were compared with a comparison group of 237 patients who did not use the inhaler, but received insulin injections instead.
One year after treatment, the researchers found that:
Blood sugar levels were similar in the two groups; 22% of patients in the inhaled insulin/insulin glargine group reached a goal A1c level of 7% or less while 27% of those solely on insulin injections reached the goal.
Patients using the inhaler gained less weight -- a major concern among diabetes patients. The inhaler group gained only an average of about 2 pounds, whereas the control group gained an average of about 5.5 pounds.
Patients using the inhaler had fewer episodes of hypoglycemia -- a sudden drop in blood sugar -- than those in the comparison group, occurring in 31% of patients on inhaled insulin/insulin glargine group vs. 49% of those in the insulin injection group.
Patients using the inhaler reported more side effects with coughing and upper respiratory infections. Most of the coughing occurred within the first 10 minutes of inhalation and primarily during the first week of treatment and declined as treatment continued.
Prior use of metformin, an oral drug commonly taken to manage blood sugar, did not affect results among the two groups of patients.
"Our findings show that inhaled insulin plus insulin glargine, alone or in combination with an oral antidiabetes drug such as metformin, is an effective alternative to conventional insulin therapy (biaspart insulin) in uncontrolled type 2 diabetes," study researcher Julio Rosenstock, MD, and colleagues write. "Inhaled insulin ... could provide improved blood sugar control with lower weight gain and rates of hypoglycaemia in many individuals with type 2 diabetes."