IDS Director of Intensive Diabetes Management, Tavia Vital
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Inhaled Insulin: When Less is More….Or More is More?
Looking for an option where less precision gives better glycemic outcomes? The usual process for improved glycemic management includes ninja-level carb counting skills and the ability to either use advanced features of automated insulin delivery systems or advanced strategies with multiple daily injections of rapid- or ultra-rapid-acting insulin with long-acting insulin.
Do you sometimes feel like all your hard work is just not paying off at the end of the day? Calculate the carbs, look at your glucose, think about the type of food and how long it might take to start pushing glucose levels up, determine how much and when to inject your mealtime insulin, inject, start a timer, do NOT get distracted or interrupted, then start eating when your pre-bolus phone alert sounds.
While this process, overall, nets the best possible results for many meal types, it still does not get all people the results they want to obtain.
In fact, in a study published by Beck, R. et al, reviewing the use of Afrezza® (technosphere inhalation insulin powder) with injected Tresiba® (insulin degludec) and a Continuous Glucose Monitor (CGM) in Diabetes Technology and Therapeutics, only about 20% of people living with Type 1 Diabetes (T1D) in the United States obtain an A1C goal of less than 7%.
The study, titled A 13-Week Single-Arm Evaluation of Inhaled Technosphere Insulin Plus Insulin
Degludec for Adults with Type 1 Diabetes showed that inhaled Afrezza® with injected Tresiba® (and a CGM) helped reduce the time glucose is above 180 mg/dL (10 mmol) after meals when compared with Multiple Daily Injections, Sensor Augmented Pump Therapy, Predictive-Low Glucose Suspend, or Automated Insulin Delivery systems.
Though the number of inhaled technosphere insulin units roughly doubles that of other therapy options, taking inhaled Afrezza® with injected Tresiba®
- Improved the daytime Time in Range (TIR) by 5% overall.
- In the MDI and SAP groups, daytime TIR increased by 8.6%.
- In the AID baseline group, the daytime TIR stayed the same when they switched to the Afrezza and Tresiba arm.
- Overnight TIR increased 2% in the MDI/SAP group but decreased in the AID baseline group during the Afrezza with Tresiba arm of the study
- A1c in the MDI/SAP group decreased by 0.36% and was unchanged in the AID group
Overall, the study demonstrated that taking Afrezza with Tresiba was non-inferior to other diabetes management strategies, which means it is comparable. If you are doing MDI and are not interested in pump therapy, or if you are currently using an AID system and want to try out a more low-tech way to manage your T1D well, this could be a great option to try!
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