Inhaled Insulin Safely Improves Blood Glucose Control in Patients With Type 2 Diabetes

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An open, randomized, parallel-group trial to compare the efficacy and safety profile of inhaled human insulin (Exubera) with metformin as adjunctive therapy in patients with type 2 diabetes poorly controlled on a sulfonylurea, by A.H. Barnett and colleagues. Diabetes Care 29:1282-1287, 2006.

What is the problem and what is known about it so far?

Eating right, exercising, and taking oral medications is the best combination for people with type 2 diabetes to improve their blood glucose levels. However, in some people with type 2 diabetes, eating better, exercising more, and taking oral medications does not always lead to target blood glucose levels.

Why did the researchers do this particular study?

The researchers wanted to see if adding inhaled insulin would safely and effectively improve type 2 diabetes treatment.

Who was studied?

Over 400 people with poorly controlled type 2 diabetes.

How was the study done?

Two groups of patients were compared: 1) those given a sulfonylurea (a drug that stimulates the pancreas to produce more insulin) plus metformin (a drug that causes the liver to produce less glucose) and 2) those given a sulfonylurea plus inhaled human insulin. The researchers compared the amount of glucose in the bloodstream before and after starting these two treatments.

What did the researchers find?

Adding inhaled human insulin to sulfonylurea treatment was safe and effective in improving the blood glucose control of patients with type 2 diabetes. The researchers noted that adding metformin to sulfonylurea treatment is preferred because combining a sulfonylurea with inhaled insulin can cause weight gain. However, some patients cannot tolerate metformin, so sulfonylurea plus inhaled insulin therapy is a good alternative and does not cause as much weight gain as other drug combinations.

What were the limitations of the study?

The study used an "open-label" design, which means that both the researchers and the patients were aware of the treatment being given. This could possibly affect the way in which the different medications were given or taken and therefore influence the results of the study.

What are the implications of the study?

Adding inhaled human insulin to sulfonylurea treatment is a good alernative to sulfonylurea plus metformin treatment for patients with poorly controlled type 2 diabetes, especially for people who have trouble taking metformin.

If inhaled insulin is as effective as injected insulin, then it could be an easier way for people with diabetes to take their insulin and maintain better long-term blood glucose control.

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