A Randomized Comparison of Postprandial Glucose Excursion Using Inhaled Insulin Versus Rapid-Acting Analog Insulin in Adults With Type 1 Diabetes Using Multiple Daily Injections of Insulin or Automated Insulin Delivery
Author:
Hirsch Irl B.1, Beck Roy W.2ORCID, Marak Martin Chase2, Calhoun Peter2ORCID, Mottalib Adham3ORCID, Salhin Amna4, Manessis Anastasios5, Coviello Andrea D.6, Bhargava Anuj7, Thorsell Ashley8, Atakov Castillo Astrid9, Bode Bruce W.10, Levister Camilla11, Levy Carol J.11ORCID, Donahue Cassandra6, Cordero Christian12, Beatson Christie13, Langel Christine R.7, Jacobson Christopher12, Kurek Corey14, Cruse Dana15, Pickering David15, Tamarez Denisa11, Steenkamp Devin W.9ORCID, Desjardins Donna14, Aleppo Grazia16ORCID, O’Malley Grenye11, Akturk Halis K.13ORCID, Diner Jamie6, Baran Jesica D.1, Buse John B.6, Ruedy Katrina2, Codorniz Kevin12, Klein Klara R.6ORCID, Castorino Kristin8ORCID, Jordan Lin Fan17, Kipnes Mark4, Church Mei Mei8ORCID, Hamdy Osama3ORCID, Raskin Philip17, Nguyen Quang T.18, Weinstock Ruth S.19ORCID, Lee Scott12, Rizvi Shafaq14, Bzdick Suzan9, Ghorbani Rodriguez Tahereh6, Salah Tareq3ORCID, Blevins Thomas20, Kudva Yogish C.14ORCID, Haider Zehra13, , Bode Bruce W., Ownby Jonathan, Johnson Joseph, Ruiz Adriana, Stephens Nashia, Maxson Amanda, Akturk Halis K., Haider Zehra, Beatson Christie, Mason Emma, Steenkamp Devin W., Wolpert Howard, Atakov-Castillo Astrid, Sullivan Asya, Kipnes Mark, Salhin Amna, Copple Tina, Beltran Stephanie, Ryan Terri, Levy Carol J., O’Malley Grenye, Levister Camilla, Tamarez Denisa, Ipek Aslihan, Bhargava Anuj, Burke Christine, Langel Christine, Bauman Shannon, Haight Cristina, Bohr Allie, Hamdy Osama, Mottalib Adham, Salah Tareq, Al Badri Marwa, Dhaver Shilton, Nguyen Quang T., Nguyen Loida, Codorniz Kevin, Lee Scott, Jacobson Christopher, Cordero Christian, Migliozzi Brittney, Kudva Yogish, Desjardins Donna, Reid Corey, Rizvi Shafaq, Kaur Ravinder Jeet, Livingood Daine, Pickering David, Cruse Dana, Aleppo Grazia, Kravarusic Jelena, Coyne Kasey, Herrmann Stefanie, Fronczyk Evelyn, Manessis Anastasios, McKillop Lorcan, Hyatt Jamie, Patruno Maria, Castorino Kristin, Church Mei Mei, Thorsell Ashley, Shuirman Maggie, Cobb Brandon, Watt Olivia, Weinstock Ruth, Bzdick Suzan, Blevins Thomas, Casaubon Luis, Espinosa Valerie, Pandit Keta, Perez Jennifer, Armstrong Chloe, Martinez-Arredondo Maritza, Stewart Ana, Johnson Olivia, Diner Jamie, Buse John, Klein Klara, Ghorbani Rodriguez Tahereh, Young Laura, Coviello Andrea D., Donahue Cassandra, Kass Alexander, Fulghum Karla, Raskin Philip, Jordan Lin, Shao Baomei, Hirsch Irl B., Baran Jesica, Mandava Patali, Holod Rosanna, Kaiserman Kevin, Ulloa Johanna, Pleitez Jennifer, Sylvan Joey, Badgett Lynn, Ruedy Katrina, Beck Roy, Borgman Sarah, Frey Sarah, Mba-Oduwusi Nnenna, Miller Paige, Fults Ashleigh, Marak Martin, Calhoun Peter, Pritchard Rosa, Dolzhenko Elizaveta, McCarthy Chris, Gabrielson Deanna, Brown Sue, Ahmann Andrew, Bergenstal Richard
Affiliation:
1. 1University of Washington, Seattle, WA 2. 2JAEB Center for Health Research, Tampa, FL 3. 3Joslin Diabetes Center, Boston, MA 4. 4Diabetes & Glandular Disease Clinic, San Antonio, TX 5. 5NYC Research, Inc., Long Island, NY 6. 6University of North Carolina, Chapel Hill, NC 7. 7Iowa Diabetes and Endocrinology Research Center, West Des Moines, IA 8. 8Sansum Diabetes Research Institute, Santa Barbara, CA 9. 9Boston Medical Center, Boston, MA 10. 10Atlanta Diabetes Associates, Atlanta, GA 11. 11Icahn School of Medicine at Mount Sinai, New York, NY 12. 12Loma Linda University, Loma Linda, CA 13. 13Barbara Davis Center for Diabetes, Denver, CO 14. 14Mayo Clinic, Rochester, MN 15. 15Mountain State Diabetes, Parkersburg, WV 16. 16Northwestern University, Chicago, IL 17. 17University of Texas Southwestern, Dallas, TX 18. 18Las Vegas Endocrinology, Henderson, NV 19. 19SUNY Upstate Medical University, Syracuse, NY 20. 20Texas Diabetes & Endocrinology, Austin, TX
Abstract
OBJECTIVE
To compare postprandial glucose excursions following a bolus with inhaled technosphere insulin (TI) or subcutaneous rapid-acting analog (RAA) insulin.
RESEARCH DESIGN AND METHODS
A meal challenge was completed by 122 adults with type 1 diabetes who were using multiple daily injections (MDI), a nonautomated pump, or automated insulin delivery (AID) and who were randomized to bolus with their usual RAA insulin (n = 61) or TI (n = 61).
RESULTS
The primary outcome, the treatment group difference in area under the curve for glucose >180 mg/dL over 2 h, was less with TI versus RAA (adjusted difference −12 mg/dL, 95% CI −22 to −2, P = 0.02). With TI, the glucose excursion was smaller (P = 0.01), peak glucose lower (P = 0.01), and time to peak glucose shorter (P = 0.006). Blood glucose <70 mg/dL occurred in one participant in each group.
CONCLUSIONS
Postmeal glucose excursion was smaller with TI than with RAA insulin in a cohort that included both AID and MDI users.
Funder
MannKind Health Research Foundation, Inc.
Publisher
American Diabetes Association
Reference4 articles.
1. Pharmacokinetic and pharmacodynamic properties of a novel inhaled insulin;Heinemann;J Diabetes Sci Technol,2017 2. Rethinking the viability and utility of inhaled insulin in clinical practice;Heinemann;J Diabetes Res,2018 3. Inhaled insulin+AID safely reduced glucose compared to AID administered RAA following in-clinic meal in proof-of-concept study data subset;Kaiserman;Diabetes Technol Ther,2023 4. Reduction in postprandial peak glucose with increased technosphere insulin dosage;Kaiserman;J Diabetes Sci Technol,2024
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