A Randomized Comparison of Post-prandial Glucose Excursion Using Inhaled Insulin Versus Rapid-acting Analogue Insulin in Adults with Type 1 Diabetes Using Multiple Daily Injections of Insulin or Automated Insulin Delivery

Objective: To compare post-prandial glucose excursions following a bolus with inhaled technosphere insulin (TI) or subcutaneous rapid-acting analogue (RAA) insulin. Research Design and Methods: A meal challenge was completed by 122 adults with type 1 diabetes using multiple daily injections (MDI), a non-automated pump, or automated insulin delivery (AID) 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 >180mg/dL over 2 hours, was less with TI versus RAA (adjusted difference, -12mg/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 <70mg/dL occurred in one participant in each group. Conclusions: Post-meal glucose excursion was smaller with TI than with RAA insulin in a cohort that included both AID and MDI users.