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Inhaled human insulin: a clinical perspective

Srikanth Bellary and Anthony H Barnett

Delivering insulin via the inhalation route is an exciting concept. Recent progress in inhalation technology has enabled development of inhaled insulin-delivery systems. Exubera^® (inhaled human insulin; INH; insulin, human [rDNA origin] Inhalation Powder) is one of several inhaled insulins being developed, and is the first inhaled insulin to obtain regulatory approval in both Europe and the USA for the treatment of diabetes. Initial experience with INH has been encouraging. It has a pharmacokinetic profile that closely mimics physiological insulin response to a meal. As a prandial insulin, its efficacy is comparable to regular subcutaneous insulin. In patients inadequately controlled on oral treatments, regimens using INH alone or in combination with oral agents achieved greater reductions in HbA1c than oral agents alone. INH also appears to be well tolerated and has high patient acceptability. Dislike for injections has often been the reason for patients declining insulin therapy or refusing to intensify existing regimens. Inhaled insulins may appeal to these patients and encourage acceptance of insulin therapy and its intensification more readily and in turn, improve glycemic control.