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Rapid Responses: Rapid Responses published:
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Inhaling insulin
- Rutger Nandorf, 59341 Västervik, Sweden (21 May 2004)
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Inhaled Insulin: better option if found cost-effective without respiratory complications!
- Dr.Naseem A. Qureshi MD, IMAPA, LMIPS (22 May 2004)
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Inhaled insulin will never be a panacea.
- Ellen H. Ullman (23 May 2004)
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Other routes of Insulin delivery?
- AK Al-Sheikhli (25 May 2004)
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Poor quality of evidence
- Vidhu Mayor (25 May 2004)
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Rutger Nandorf, Consultant in endocrinology Västervik hospital, 59341 Västervik, Sweden
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Inhaling insulin is a very unphysiological way of administering this hormone, and it is easy to realise, that it will not work in the long run. Bronchi and alveoli are not made for absorbing insulin. Competing interests: None declared |
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Dr.Naseem A. Qureshi MD, IMAPA, LMIPS, Medical Director(A), Director CME&R Buraidah Mental Health Hospital, Postcode:2292, Saudi Arabia
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Sir: This editorial by Amiel and Alberti (2004) is informative and diabetic population in particular those who hate taking insulin injections everyday will have a sigh of relief if inhaled insulin, either in powder or aerosol form is found cost-effective without longterm respiratory or other complications. Diabetes mellitus, infantile or adult onset types/type 1 or type 2 is one of the chronic medical diseases associated with a variety of psychiatric disorders in particular depression and multiple infarct dementia and also cause other multiple bodily complications such as renal failure, blindness, diabetic foot, coronary heart disease and others. This metabolic disease, a risk factor for causing other medical problems, is also associated with chronic physical and psychosocial disability and incurs huge financial burden worldwide. In particualar patients having type 1 diabetes, many of them don't like to take insulin injections and tend to develop multiple complications of poor compliance. Certainly, some of them take insulin injections but they prefer and welcome better option which can circumvent the problem of insulin injections. Inhaled insulin if found cost-effective, good bioavailability and without any longterm lung complications would change the treatment dynamics in particular the poor drug compliance associated with insulin injections hesitantly taken by diabetic population around the world. Reference: Stephanie A Amiel and K George M M Alberti. Inhaled insulin. BMJ 2004; 328: 1215-1216 Competing interests: None declared |
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Ellen H. Ullman, Parent of child with type 1 diabetes www.kidsrpumping.com
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Your editorial states: "...healthcare professionals remain uneasy about the concept of injections." Physicians must stop threatening patients with type 2 diabetes that if the patients don't do well, they'll have to go on injections. Many of those patients should have been started on insulin and should have been empowered to know that insulin would improve their well being very early on from diagnosis. It's absurd that a respected medical journal would even hint that inhalable insulin may prove to be a "panacea". Insulin itself is not a panacea, it's a life sustaining hormone fraught with challenges. It does not act like a beta cell in response to circulating glucose levels. From: http://biz.yahoo.com/prnews/040517/nem004_1.html "Unlike conventional dry-powder inhalers, Nektar's Inhance dry-powder inhaler technology is designed to deliver the correct dosage independent of the patient's inspiratory flow rate," said Carole Gleeson, analyst at Decision Resources. "While thought leaders are enthusiastic about the potential for a more convenient method of delivery, adverse side effects, namely pulmonary fibrosis, remain a major concern." Why are the aspects of the studies that show inhalable insulin having the potential to cause pulmonary fibrosis being ignored? Pulmonary fibrosis is a devastating and debilitating disease . I hope the FDA is paying attention. Do patients with diabetes not suffer enough already? Must we add "diabetic lung" to the list of complications? Your editorial states"...current published trials report no deleterious effects over the short-term". In the ADA 2004 abstract number 454-P "Efficacy and One-Year Pulmonary Safety of Inhaled Insulin (Exubera®) as Adjunctive Therapy with Metformin or Glibenclamide in Type 2 Diabetes Patients Poorly Controlled on Oral Agent Monotherapy", ANTHONY H. BARNETT, FOR THE EXUBERA® PHASE III STUDY GROUP, the researchers "... conclude that inhaled insulin (Exubera®) ... suggest that any possible changes in pulmonary function are small, similar between treatment groups, and non-progressive. " Any loss of pulmonary function as a result of this treatment is too much! We need a CURE for type 1 diabetes, not another disease to go along with it. Very sincerely yours, Ellen H. Ullman Mom, Advocate for children who have diabetes and their parents, Friend, Webmaster.. www.kidsrpumping.com Competing interests: None declared |
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AK Al-Sheikhli, Consultant Psychiatrist Medical Centre,Nuneaton,CV11 5HX,UK
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EDITOR--It was interesting to read the Editorial of Amiel and Alberti, Inhaled Insulin [Journal(2004);328(7450):1215]. My comment: It is more appropriate to try to use other routes such as oral, sublingual, rectal, and skin routes. (1) Reference 1.Owens DR, Zinman B, Bolli G. Alternate routes of insulin delivery. Diabet Med (2003)20(11);886-98. Competing interests: None declared |
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Vidhu Mayor, General Practitioner LaNe Medical Centre,52 Chesterton Rd Birmingham B12 8HE
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Dear Editor RE: inhaled insulin (BMJ 2004:328:1215-6) I was astounded to read, that the authors of your editorial referenced above, are suggesting that "health care professionals and patients start to use insulin much earlier and more aggressively in type 2 diabetes". Is this type of enthusiasium not only very inappropriate, but also totally premature, in light of the very poor quality of evidence regarding the progression of diabetic complications. The results of the UKPDS study (BMJ 2003:327:266-9) was that tight glycaemic control did not prevent premature mortality nor had any effect on any individual micro vascular complication. Yours sincerely
Competing interests: None declared |
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