Inhaled Insulin and Needle Avoidance

For decades, people with diabetes who need to take insulin[1] — everyone with Type 1 diabetes[2], and some people with Type 2[3] — had no choice but to inject it with a syringe or, later on, an insulin pen or pump[4]. Then, in 2006, what many of these people had long been waiting for finally arrived: a way to take insulin without a needle.


The excitement didn’t last very long — Exubera, the first commercially available inhaled insulin, was hampered by a bulky inhaler and high prices that many insurance companies didn’t cover, leading to its withdrawal from the market in 2007[5]. But last year, the U.S. Food and Drug Administration (FDA) approved a new inhaled insulin, Afrezza, that seems to stand a better chance commercially — due in part to[6] its faster peak of action and its smaller inhaler. Its manufacturer, MannKind, has high hopes that its delivery system will be used in the future for many other drugs that must currently be injected.

A new study shows the extent to which avoiding needles is central to the marketing strategy for Afrezza. Published earlier this month[7] in the journal Diabetes Care, the study shows that in people whose Type 2 diabetes isn’t adequately controlled with oral drugs, adding Afrezza can significantly improve blood glucose control, as shown by HbA1c[8] level (a measure of long-term blood glucose control). As noted in a Healio article on the study[9], the average HbA1c level of the 177 study subjects who took Afrezza dropped from 8.3% to 7.5%. Among the 176 subjects who took an inhaled placebo (inactive inhalation) instead, HbA1c dropped only to 7.9%. More members of the Afrezza group also saw a drop in HbA1c to 7% or less — the recommended target for many people with diabetes, according to American Diabetes Association guidelines.

What’s notable about this study, aside from its results, is that it lacked any testing of long-acting injected insulin, which is often the first type of insulin that doctors prescribe for people with Type 2 diabetes when oral drugs alone are no longer enough.

Many people with Type 2 diabetes who have never injected insulin are, understandably, apprehensive about injections. But many also find that a once-daily injection isn’t that big of a deal. Still other people with Type 2 diabetes — as shown in[10] their comments on[11] previous blog posts about inhaled insulin — don’t mind once-daily injections of long-acting insulin, but loved that with inhaled insulin, they could avoid multiple daily mealtime injections. But MannKind probably notes that there are far more people with Type 2 diabetes who don’t inject insulin — and don’t want to — than those who already inject multiple times daily, but want to reduce this number.

What’s your take on inhaled insulin and injections — would you rather start taking inhaled insulin at every meal, or a once-daily insulin injection? If you already take multiple mealtime injections, would you rather replace these with inhaled insulin? Do you think that fear of injections is often out of sync with reality, or do you find that the pain and possible complications of injections are significant drawbacks? Would you prefer the most common side effect of inhaled insulin — a persistent dry cough — over possible side effects of injections, such as lumps (lipohypertrophy) at injection sites? Leave a comment below!

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  5. withdrawal from the market in 2007:
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  7. Published earlier this month:
  8. HbA1c:
  9. article on the study:
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