Treatment with Afrezza® (insulin human) inhalation powder in individuals with type 1 diabetes (T1D) reduces HbA1c levels similar to rapid-acting insulin analogs, but with significantly less hypoglycemia due to its unique time action profile. Examinations of studies of Afrezza pharmacokinetics/pharmacodynamics, relevant clinical trials, and U.S. Food and Drug Administration (FDA) documentation suggest that current FDA-mandated dosing recommendations for initiating Afrezza treatment may not result in optimal glycemic control for individuals with T1D. Recommendations for initiating Afrezza insulin therapy in T1D patients are presented in this article.
Get full access to this article
View all access options for this article.
References
1.
CryerPE. Hypoglycemia: still the limiting factor in the glycemic management of diabetes. Endocr Pract, 2008; 14:750–756.
2.
GroupUKHS. Risk of hypoglycaemia in types 1 and 2 diabetes: effects of treatment modalities and their duration. Diabetologia, 2007; 50:1140–1147.
3.
MillerKM, FosterNC, BeckRW, et al.Current state of type 1 diabetes treatment in the U.S.: updated data from the T1D Exchange clinic registry. Diabetes Care, 2015; 38:971–978.
4.
LundkvistJ, BerneC, BolinderB, JonssonL. The economic and quality of life impact of hypoglycemia. Eur J Health Econ, 2005; 6:197–202.
5.
GiordaCB, OzzelloA, GentileS, et al.Incidence and risk factors for severe and symptomatic hypoglycemia in type 1 diabetes. Results of the HYPOS-1 study. Acta Diabetol, 2015; 52:845–853.
6.
CariouB, FontaineP, EschwegeE, et al.Frequency and predictors of confirmed hypoglycaemia in type 1 and insulin-treated type 2 diabetes mellitus patients in a real-life setting: results from the DIALOG study. Diabetes Metab, 2015; 41:116–125.
7.
SmithCB, ChoudharyP, PernetA, et al.Hypoglycemia unawareness is associated with reduced adherence to therapeutic decisions in patients with type 1 diabetes: evidence from a clinical audit. Diabetes Care, 2009; 32:1196–1198.
8.
WildD, von MaltzahnR, BrohanE, et al.A critical review of the literature on fear of hypoglycemia in diabetes: implications for diabetes management and patient education. Patient Educ Couns, 2007; 68:10–15.
9.
HaugstvedtA, Wentzel-LarsenT, GraueM, et al.Fear of hypoglycaemia in mothers and fathers of children with Type 1 diabetes is associated with poor glycaemic control and parental emotional distress: a population-based study. Diabet Med, 2010; 27:72–78.
10.
MKC-TI-171. Trial 171: a Phase 3, Multicenter, Open-Label, Randomized, Forced-Titration Clinical Trial Evaluating the Efficacy and Safety of Technosphere® Insulin Inhalation Powder in Combination with a Basal Insulin Versus Insulin Aspart in Combination with a Basal Insulin in Subjects with Type 1 Diabetes Mellitus Over a 24-Week Treatment Period. 2013. Clinical Trials.gov identifier NCT01445951. https://clinicaltrials.gov ct2/show/NCT01445951?term = NCT01445951&rank = 1 (accessed March30, 2017).
11.
BodeBW, McGillJB, LorberDL, et al.Inhaled Technosphere insulin compared with injected prandial insulin in type 1 diabetes: a randomized 24-week trial. Diabetes Care, 2015; 38:2266–2273.
HeinemannL, ParkinCG. Rethinking the viability and utility of inhaled insulin in clinical practice. J Diabetes Res, 2018; article ID4568903, 9 pp.
14.
HeinemannL, BaughmanR, BossA, HompeschM. Pharmacokinetic and pharmacodynamic properties of a novel inhaled insulin. J Diabetes Sci Technol, 2017; 11:148–156.
15.
VisentinR, GiegerichC, JagerR, et al.Improving efficacy of inhaled technosphere insulin (Afrezza) by postmeal dosing: in-silico clinical trial with the University of Virginia/Padova type 1 diabetes simulator. Diabetes Technol Ther, 2016; 18:574–585.
