Evolution of a Pulmonary Insulin Delivery System ( Exubera) for Patients With Diabetes

Priscilla A. Hollander, MD

Disclosures

March 05, 2007

Patient-Reported Outcomes With INH

The clinical benefits of INH inhaled insulin therapy extend to improved treatment satisfaction compared with SC insulin (in both type 1 and type 2 diabetes) or OAs (in type 2 diabetes). Rosenstock and colleagues[27] performed a pooled analysis of patient satisfaction data from the two 12-week parent studies and 1-year extension studies in patients with type 1 (n = 70) or type 2 (n = 51) diabetes who received either INH or SC insulin. Of the 60 patients who received INH in the parent studies, 51 (85%) chose to continue with the same treatment in the extension studies compared with only 13 of the 61 patients (21%) who received SC insulin. Of note, 75% of patients who were receiving SC insulin elected to switch to INH during the study extension compared with only 13% who chose to switch from INH to SC insulin.

After 1 year, patients receiving INH reported greater mean improvements in overall satisfaction with treatment (37.9% vs 3.1% with SC insulin; P < .01) and in ease of use (43.2% vs -0.9% with SC insulin; P < .01).[27] It should be noted, however, that the INH treatment group had increased to 95 patients (vs only 17 patients receiving SC insulin), because most of the patients originally treated with SC insulin switched to INH when given the opportunity.

Freemantle and colleagues[28] examined how the availability of inhaled insulin affected theoretical treatment choices in 779 patients with type 2 diabetes that was poorly controlled (ie, HbA1c > 8%) despite dietary measures and treatment with up to 3 OAs. Patients received information about currently available treatment options (OAs and/or SC insulin; n = 388) or current treatments and INH inhaled insulin (n = 391), and were then asked to choose treatment.

Of the patients offered INH, 43% (169 of 391 patients) opted for an insulin-containing regimen compared with only 15% (60 of 388 patients) of those who were offered standard available therapies only (P < .0001). Furthermore, 43% of the patients offered standard therapies chose not to make any changes to their existing therapy regardless of having poor glycemic control. Of interest, 35% (138 of 391 patients) of patients who were offered INH chose it as their preferred treatment option.[28] The results of this study showed that patients would choose insulin if available in an inhaled formulation, suggesting an opportunity to improve glycemic control with insulin.

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