June 30, 2014 -- Millions of people with type 1 or type 2 diabetes will have another treatment option now that the FDA has approved an inhaled insulin.
Called Afrezza, the rapid-acting insulin is taken before each meal, or soon after starting to eat, with no needles required. Afrezza won't replace the need for injected long-acting insulin for those who need it, though.
WebMD asked diabetes experts about this newest option:
How is Afrezza different than other insulin?
Because it's inhaled, it's absorbed more quickly and in a different way.
"Afrezza is rapidly absorbed from the cells in the lungs [to the blood stream]," says R. Keith Campbell, RPh. He's a certified diabetes educator and distinguished professor emeritus in diabetes care and pharmacotherapy at Washington State University College of Pharmacy. He has studied the drug but has no ties to its developer.
"From the time you inhale it to the time it actually peaks [in the blood] is 15 to 20 minutes," Campbell says. Injected insulin taken before a meal, he says, takes about an hour to peak.
The body also clears Afrezza more quickly than insulin injected at mealtime, says Bruce Bode, MD. He's a diabetes specialist in Atlanta who did a clinical trial funded by MannKind Corporation, the drug’s developer.
Besides its rapid peak, the drug is ''pretty much gone in 2 or 3 hours," Bode says. Rapid-acting injected insulins, he says, usually ''hang around for about 4 hours. Afrezza is fast in, fast out. It is emulating, in essence, what the pancreas does."
How is it taken?
Users place a dose of Afrezza, in powder form, into a small, whistle-sized inhaler. Doses come in a cartridge, and each cartridge contains a single dose.
How does Afrezza work compared to rapid-acting injected insulins?
In a 24-week study, Bode compared Afrezza with a rapid-acting, injected insulin in more than 500 patients with type 1 diabetes. Afrezza and injected insulin controlled blood sugar equally well, he says. But he found that those using Afrezza were less likely to get very low blood sugar, a complication of insulin use.
With Afrezza, "there is also less weight gain," Bode says. He credits that to the shorter time Afrezza remains in the body.
In another study, researchers found that people with type 2 diabetes who weren't getting enough control of blood sugar with oral medications did better when they added inhaled insulin before meals.
Both studies were presented at the American Diabetes Association meeting in June.
The FDA approved Afrezza's safety and effectiveness based on about 3,000 people, including 1,000 with type 1 diabetes and about 2,000 with type 2.
What about side effects?
In the Afrezza clinical trials, the most commonly reported side effects were low blood sugar, cough, and throat pain or irritation, according to the FDA.
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