Published online Dec 15, 2016. doi: 10.4239/wjd.v7.i20.599
Peer-review started: July 21, 2016
First decision: September 5, 2016
Revised: September 20, 2016
Accepted: October 17, 2016
Article in press: October 18, 2016
Published online: December 15, 2016
Processing time: 143 Days and 6.8 Hours
Technosphere insulin (TI), Afrezza, is a powder form of short-acting regular insulin taken by oral inhalation with meals. Action of TI peaks after approximately 40-60 min and lasts for 2-3 h. TI is slightly less effective than subcutaneous insulin aspart, with mean hemoglobin A1c (HbA1c) reduction of 0.21% and 0.4%, respectively. When compared with technosphere inhaled placebo, the decrease in HbA1c levels was 0.8% and 0.4% with TI and placebo, respectively. Compared with insulin aspart, TI is associated with lower risk of late post-prandial hypoglycemia and weight gain. Apart from hypoglycemia, cough is the most common adverse effect of TI reported by 24%-33% of patients vs 2% with insulin aspart. TI is contraindicated in patients with asthma and chronic obstructive pulmonary disease. While TI is an attractive option of prandial insulin, its use is limited by frequent occurrence of cough, need for periodic monitoring of pulmonary function, and lack of long-term safety data. Candidates for use of TI are patients having frequent hypoglycemia while using short-acting subcutaneous insulin, particularly late post-prandial hypoglycemia, patients with needle phobia, and those who cannot tolerate subcutaneous insulin due to skin reactions.
Core tip: Technosphere insulin is the only approved form of inhaled insulin. It is a short-acting insulin that can be taken with meals in patients with type 1 or type 2 diabetes. In this minireview, the author provides an appraisal of this new formulation of insulin to help determine its place in the management of diabetes.