Efficacy of inhaled human insulin in type 1 diabetes mellitus: A randomised proof-of-concept study

Jay S. Skyler, William T. Cefalu, Ione A. Kourides, William H. Landschulz, Cecile C. Balagtas, Shu Lin Cheng, Robert A. Gelfand

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291 Scopus citations

Abstract

Background: Effective glycaemic control in type 1 diabetes mellitus usually requires two or more insulin injections daily. Inhaled intrapulmonary delivery of insulin offers a potential new way to deliver meal-related insulin, eliminating the need for preprandial injections. Methods: 73 patients with type 1 diabetes mellitus were studied in an open-label, proof-of-concept, parallel-group randomised trial. Patients in the experimental group received preprandial inhaled insulin plus a bedtime subcutaneous ultralente insulin injection. Patients in the control group received their usual insulin regimen of two to three injections per day. Participants monitored their blood glucose four times daily, and adjusted insulin doses weekly to achieve preprandial glucose targets of 5.6-8.9 mmol/L. The primary outcome measure was change in glycosylated haemoglobin (HbA1c) after 12 weeks. Secondary outcomes were fasting and postprandial glucose response to a mixed meal; hypoglycaemia frequency and severity; pulmonary function; and patients' satisfaction. Findings: Changes in HbA1c were indistinguishable between groups (difference 0.2% [95% Cl -0.2 to 0.5]). Changes in fasting and postprandial glucose concentrations, and occurrence and severity of hypoglycaemia were also similar between groups. Inhaled insulin was well tolerated and had no effect on pulmonary function (ie, spirometry, lung volumes, diffusion capacity, and oxygen saturation). Interpretation: This proof-of-concept study shows that preprandial insulin can be given by inhalation in individuals with insulin-deficient type 1 diabetes as a less invasive alternative to conventional preprandial insulin injections.

Original languageEnglish (US)
Pages (from-to)331-335
Number of pages5
JournalLancet
Volume357
Issue number9253
DOIs
StatePublished - Feb 3 2001

ASJC Scopus subject areas

  • Medicine(all)

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    Skyler, J. S., Cefalu, W. T., Kourides, I. A., Landschulz, W. H., Balagtas, C. C., Cheng, S. L., & Gelfand, R. A. (2001). Efficacy of inhaled human insulin in type 1 diabetes mellitus: A randomised proof-of-concept study. Lancet, 357(9253), 331-335. https://doi.org/10.1016/S0140-6736(00)03638-2