title: The effect of the availability of inhaled insulin on glycaemic control in patients with Type 2 diabetes failing on oral therapy: the evaluation of Exubera as a therapeutic option on insulin initiation and improvement in glycaemic control in clinical practice (EXPERIENCE) trial.
abstract: OBJECTIVE
  To examine the impact of inhaled human insulin (Exubera, EXU) on patient or physician willingness to adopt insulin after oral glucose-lowering agent failure.
  
  
  METHODS
  During a randomized controlled trial in primary, secondary and tertiary care in Europe and North America, 739 patients using >or= 2 oral glucose-lowering agents with glycated haemoglobin (HbA(1c)) >or= 8.0% were assigned to two treatment groups: Group 1 (standard care with the option of EXU) or Group 2 (standard care only). Standard care included adjusting oral therapy (optimizing current regimen or adding/omitting agents) and/or initiating subcutaneous (s.c.) insulin. The primary endpoint was difference in HbA(1c) between randomized groups at 26 weeks. Secondary outcomes included differences in the rate of uptake of insulin therapy, proportion achieving satisfactory glycaemic control, treatment satisfaction and safety outcomes.
  
  
  RESULTS
  At baseline, insulin was initiated by more [odds ratio 6.0; 95% confidence interval (CI) 4.2 to 8.8; P < 0.0001] patients in Group 1 (86.2%; 76.7% EXU plus 9.5% s.c.) than Group 2 (50.7%; s.c. insulin only). At 26 weeks, mean (sd) changes in HbA(1c) from baseline were -2.0% (1.2%) and -1.7% (1.3%) in Groups 1 and 2, respectively, a difference of -0.2% (95% CI: -0.1% to -0.4%; P = 0.004). In Group 1, 45% of patients achieved an HbA(1c)<or= 7.0% by 26 weeks compared with 39% in Group 2 (P = 0.02).
  
  
  CONCLUSIONS
  The availability of EXU may increase initiation of insulin, thereby contributing to improved overall glycaemic control in patients with Type 2 diabetes inadequately controlled on two or more oral glucose-lowering agents.
authors.affiliation: Ochsner Health System, New Orleans, LO, USA.
authors.forename: S
authors.initials: S
authors.lastname: Del Prato
authors.forename: L
authors.initials: L
authors.lastname: Blonde
authors.forename: L
authors.initials: L
authors.lastname: Martinez
authors.forename: B
authors.initials: B
authors.lastname: Göke
authors.forename: V
authors.initials: V
authors.lastname: Woo
authors.forename: A
authors.initials: A
authors.lastname: Millward
authors.forename: R
authors.initials: R
authors.lastname: Gomis
authors.forename: B
authors.initials: B
authors.lastname: Canovatchel
authors.forename: T
authors.initials: T
authors.lastname: Strack
authors.forename: D
authors.initials: D
authors.lastname: Lawrence
authors.forename: N
authors.initials: N
authors.lastname: Freemantle
mesh_terms: D000280:Administration, Inhalation; D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000187:drug effects; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000188:drug therapy*; D004333:Drug Administration Routes; D005060:Europe; D005260:Female; D006442:Glycated Hemoglobin / Q000187:drug effects; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D007328:Insulin / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D009656:North America; D016896:Treatment Outcome
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin; C473734:Exubera