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.

Irl B Hirsch, Roy W Beck, Martin Chase Marak, Peter Calhoun, Adham Mottalib, Amna Salhin, Anastasios Manessis, Andrea D Coviello, Anuj Bhargava, Ashley Thorsell, Astrid Atakov Castillo, Bruce W Bode, Camilla Levister, Carol J Levy, Cassandra Donahue, Christian Cordero, Christie Beatson, Christine R Langel, Christopher Jacobson, Corey Kurek, Dana Cruse, David Pickering, Denisa Tamarez, Devin W Steenkamp, Donna Desjardins, Grazia Aleppo, Grenye O'Malley, Halis K Akturk, Jamie Diner, Jesica D Baran, John B Buse, Katrina Ruedy, Kevin Codorniz, Klara R Klein, Kristin Castorino, Lin Fan Jordan, Mark Kipnes, Mei Mei Church, Osama Hamdy, Philip Raskin, Quang T Nguyen, Ruth S Weinstock, Scott Lee, Shafaq Rizvi, Suzan Bzdick, Tahereh Ghorbani Rodriguez, Tareq Salah, Thomas Blevins, Yogish C Kudva, Zehra Haider

Journal: Diabetes care 2024;47(9):1682-1687

PMID: 39042575

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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.

Address: University of Washington, Seattle, WA.; JAEB Center for Health Research, Tampa, FL.; Joslin Diabetes Center, Boston, MA.; Diabetes & Glandular Disease Clinic, San Antonio, TX.; NYC Research, Inc., Long Island, NY.; University of North Carolina, Chapel Hill, NC.; Iowa Diabetes and Endocrinology Research Center, West Des Moines, IA.; Sansum Diabetes Research Institute, Santa Barbara, CA.; Boston Medical Center, Boston, MA.; Atlanta Diabetes Associates, Atlanta, GA.; Icahn School of Medicine at Mount Sinai, New York, NY.; Loma Linda University, Loma Linda, CA.; Barbara Davis Center for Diabetes, Denver, CO.; Mayo Clinic, Rochester, MN.; Mountain State Diabetes, Parkersburg, WV.; Northwestern University, Chicago, IL.; University of Texas Southwestern, Dallas, TX.; Las Vegas Endocrinology, Henderson, NV.; SUNY Upstate Medical University, Syracuse, NY.; Texas Diabetes & Endocrinology, Austin, TX.

DOI: 10.2337/dc24-0838

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MeSH Terms: Humans, Diabetes Mellitus, Type 1, Blood Glucose, Adult, Insulin, Male, Female, Administration, Inhalation, Middle Aged, Hypoglycemic Agents, Postprandial Period, Insulin Infusion Systems, Insulin, Short-Acting