The role of inhaled insulin in the treatment of type 2 diabetes

With the increasing prevalence of type 2 diabetes, it is imperative that health care providers adopt a more aggressive treatment approach to optimize glycemic control and to reduce the incidence of and costs associated with diabetes-related morbidity and mortality. Despite the well-recognized benefits of improved glycemic control in patients with type 2 diabetes, the majority of patients still have poor glycemic control. Diabetes is a progressive disease, and many patients who initially achieve glycemic control with oral therapy will eventually require the addition of insulin to maintain glycemic control. Subcutaneous injections, however, represent a barrier to patients' initiation of insulin therapy, and alternative methods of insulin delivery are likely to be viewed positively by patients and physicians. The recent approval of Exubera (Pfizer, New York, NY), a novel inhaled insulin delivery system for patients with type I or type 2 diabetes, may alleviate some of the barriers to the initiation of insulin. In studies in patients with type 2 diabetes, Exubera. provided effective glycemic control that was comparable to that seen with subcutaneous insulin and superior to that seen with oral therapy, with a favorable safety and tolerability profile. Exubera can reduce the need for daily insulin injections and may become a useful alternative to existing treatments for the management of type 2 diabetes. Greater acceptance of new insulin delivery systems may lead to earlier introduction of insulin therapy, which should help more patients with diabetes achieve glycemic control sooner after diagnosis. (C) 2008 Elsevier Inc. All rights reserved.