Patient Selection for Inhaled Insulin in Type 1 Diabetes

Diana Isaacs, PharmD, BCPS, BCACP, BC-ADM, CDCES: I want to take a moment just to mention the FDA-approved populations for inhaled insulin. At the current time, this is a rapid-acting insulin that is indicated to improve glycemic control in adult patients with diabetes. At this time, it does not have a pediatric indication, so it is for ages 18 years and over, but it is FDA-approved for both type 1 and type 2 diabetes. I’m emphasizing that it’s a mealtime insulin. The key would be that someone is currently on a basal insulin and on a background insulin. They would still need a different insulin for that. This is meant for the mealtime insulin. I’m curious about who would not be the best candidate for inhaled insulin.

Natalie Bellini, DNP, FNP-BC: If any medication is going to go through the lungs, we need to think about lung challenges for patients. We can’t use it in smokers, and that makes sense right away. Chronic lung disease such as asthma or chronic obstructive pulmonary disease, COPD, even if the patient has stopped smoking, and if they have developed COPD. We cannot do this because of the risk of acute bronchospasm. Those are the big lung disease issues and then, it’s not indicated in pregnancy. Although animal data look like they would be safe, they have not been studied. Although, when you look at some of these postprandial numbers and both of us kind of jump at, “Wouldn’t this be amazing?” but it’s not FDA approved at this time.

Diana Isaacs, PharmD, BCPS, BCACP, BC-ADM, CDCES: Exactly. Those are great points. Of course, we’re not going to use it for an acute emergency like DKA [diabetic ketoacidosis] or anything like that. What do we know about glucose management with inhaled insulin from clinical trials? I would have you rack your brain about all the clinical data floating around in your head. Can you share some of that?

Natalie Bellini, DNP, FNP-BC: One of the things that we know from the STAT study is that, overall, those with type 1 on aspart, which is one of the mealtime insulins, achieved comparable time and range. Dr Isaacs and I are big time-and-range fans because it’s an easily explainable statistic to a patient, that we want them, since most of the patients, 70 to 180 70% of the time and reducing those highs and lows. When you compare it to aspart, the time and range is similar, but less time spent hypoglycemic. That all by itself is because of that not overtreating those highs. What do you think?

Transcript edited for clarity