Abstract
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/L·h vs. 426 ± 89 mmol/L·h; 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.
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