Glycemic exposure is affected favorably by inhaled human insulin (Exubera) as compared with subcutaneous insulin glargine (Lantus) in patients with type 2 diabetes.
BACKGROUND
The objective was to compare the effects on glycemia of adding either inhaled human insulin (Exubera [EXU] [insulin human (recombinant DNA origin) inhalational powder]) or subcutaneous insulin glargine (GLA) to the treatment regimens of patients with type 2 diabetes uncontrolled with oral antidiabetic drugs.


METHODS
Forty patients were randomized to receive either EXU three times daily prior to meals or subcutaneous GLA once daily in a crossover design. Interstitial glucose concentrations were monitored using a continuous glucose monitoring system (CGMS) for the final 72-h period of 8 treatment days.


RESULTS
Total insulin dosage on the last treatment day was approximately 40.1+/-18.1 units/day EXU compared with 16.4+/-4.8 units/day GLA. Serum insulin levels over the 72-h CGMS period were higher for EXU than for GLA (1,091+/-589 pmol/mL/h vs. 737+/-386 pmol/mL/h; ratio, 148; 95% confidence interval [CI], 130-169). The glucose exposure over this period was lower with EXU than with GLA (380+/-45 mmol/Lh vs. 426+/-89 mmol/Lh; ratio, 88.57; 95% CI, 84-93). The overall hypoglycemic event rate was 8.7 events per subject-month for EXU and 2.4 for GLA.


CONCLUSIONS
Prandial insulin therapy with EXU, using a higher daily insulin dose, reduces total daily glucose exposure--in particular postmeal glycemia--more effectively than a basal insulin analog.
Hompesch
Marcus
M
Profil Institute for Clinical Research Inc., Chula Vista, California 91911, USA. marcus.hompesch@profil-research.com
Kollmeier
Alexa
A
Rave
Klaus
K
Heinemann
Lutz
L
Mitnick
Michael
M
Davies
Simon
S
Strack
Thomas
T
D000280:Administration, Inhalation; D001786:Blood Glucose / Q000032:analysis / Q000187:drug effects / Q000378:metabolism*; D018592:Cross-Over Studies; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000188:drug therapy*; D006801:Humans; D007279:Injections, Subcutaneous; D007328:Insulin / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000627:therapeutic use; D000069036:Insulin Glargine; D049528:Insulin, Long-Acting; D018670:Monitoring, Ambulatory / Q000379:methods
D001786:Blood Glucose; C473734:Exubera; D007328:Insulin; D049528:Insulin, Long-Acting; D000069036:Insulin Glargine