Inhaled Insulin for Type 2 Diabetes: Solution or Distraction?

Editorials6 February 2001Inhaled Insulin for Type 2 Diabetes: Solution or Distraction?David M. Nathan, MDDavid M. Nathan, MDDr. Nathan: Massachusetts General Hospital; Boston, MA 02114Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-134-3-200102060-00016 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail The second most famous “shot heard”—or felt—“round the world” was a 5-mL injection of pancreatic extract given to Leonard Thompson, a 13-year-old patient dying of diabetes, on 23 January 1922 (1). The extract had been prepared by Dr. J.B. Collip on the basis of the seminal work by Banting and Best (2). The insulin, as it came to be called, was relatively dilute—Thompson received 45 mL in the next 36 hours—and caused sterile abscesses. It was administered by using a glass-barreled syringe and probably a 21-gauge needle. Because the only insulin available in those early years was relatively short acting, ...References1. Banting FG, Best CH, Collip JB, Campbell WR, Fletcher AA. Pancreatic extracts in the treatment of diabetes mellitus. Preliminary report. Can Med Assoc J. 1922;2:141-6. Google Scholar2. Bliss M. The Discovery of Insulin. Chicago: Univ of Chicago Pr; 1982. Google Scholar3. Zinman B. The physiologic replacement of insulin. An elusive goal. N Engl J Med. 1989;321:363-70. CrossrefMedlineGoogle Scholar4. . The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. The Diabetes Control and Complications Trial Research Group. N Engl J Med. 1993;329:977-86. CrossrefMedlineGoogle Scholar5. . Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). UK Prospective Diabetes Study (UKPDS) Group. Lancet. 1998;352:837-53. CrossrefMedlineGoogle Scholar6. Galloway JA, Spradlin CT, Howey DC, Dupre J. Intrasubject differences in pharmacokinetic and pharmacodynamic responses: The immutable problem of present day treatment?. In: Serrano-Rios M, Lefèbvre PJ, eds. Diabetes 1985: Proceedings of the 12th Congress of the International Diabetes Federation, Madrid, 23–28 September 1985. Amsterdam: Elsevier Science; 1985. Google Scholar7. Crofton WM. Pancreatic extract in diabetes [Letter]. Lancet. 1922:1195. Google Scholar8. Dunn FL, Nathan DM, Scavini M, Selam JL, Wingrove TG. Long-term therapy of IDDM with an implantable insulin pump. The Implantable Insulin Pump Trial Study Group. Diabetes Care. 1997;20:59-63. CrossrefMedlineGoogle Scholar9. Malone JI, Lowitt S, Grove NP, Shah SC. Comparison of insulin levels after injection by jet stream and disposable insulin syringe. Diabetes Care. 1986;9:637-40. CrossrefMedlineGoogle Scholar10. Cefalu WT, Skyler JS, Kourides IA, Landschulz WH, Balagtas CC, Cheng SL, et al . Inhaled human insulin treatment in patients with type 2 diabetes mellitus. Ann Intern Med. 2001;134:203-7. LinkGoogle Scholar11. Laube BL, Benedict GW, Dobs AS. Time to peak insulin level, relative bioavailability, and effect of site of deposition of nebulized insulin in patients with noninsulin-dependent diabetes mellitus. J Aerosol Med. 1998;11:153-73. CrossrefMedlineGoogle Scholar12. Nathan DM, Roussell A, Godine JE. Glyburide or insulin for metabolic control in non–insulin-dependent diabetes mellitus. A randomized, double-blind study. Ann Intern Med. 1988;108:334-40. LinkGoogle Scholar13. Yki-Jarvinen H, Ryysy L, Nikkila K, Tulokas T, Vanamo R, Heikkila M. Comparison of bedtime insulin regimens in patients with type 2 diabetes mellitus. A randomized, controlled trial. Ann Intern Med. 1999;130:389-96. LinkGoogle Scholar14. Skyler JS, Gelfand RA, Kourides IA. Treatment of Type 1 diabetes mellitus with inhaled human insulin: a 3-month multicenter trial [Abstract]. The Inhaled Insulin Phase II Study Group. Diabetes. 1998;47 Suppl 1 A61. Google Scholar15. Laube BL, Georgopoulos A, Adams GK. Preliminary study of the efficacy of insulin aerosol delivered by oral inhalation in diabetic patients. JAMA. 1993;269:2106-9. CrossrefMedlineGoogle Scholar16. Garvey WT, Olefsky JM, Griffin J, Hamman RF, Kolterman OG. The effect of insulin treatment on insulin secretion and insulin action in type II diabetes mellitus. Diabetes. 1985;34:222-34. CrossrefMedlineGoogle Scholar17. Turner RC, Holman RR. Beta cell function during insulin or chlorpropamide treatment of maturity-onset diabetes mellitus. Diabetes. 1978;27 Suppl 1 241-6. CrossrefMedlineGoogle Scholar18. Cusi K, Cunningham GR, Comstock JP. Safety and efficacy of normalizing fasting glucose with bedtime NPH insulin alone in NIDDM. Diabetes Care. 1995;18:843-51. CrossrefMedlineGoogle Scholar19. Ilkova H, Glaser B, Tunckale A, Bagriacik N, Cerasi E. Induction of long-term glycemic control in newly diagnosed type 2 diabetic patients by transient intensive insulin treatment. Diabetes Care. 1997;20:1353-6. CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: Dr. Nathan: Massachusetts General Hospital; Boston, MA 02114Corresponding Author: David M. Nathan, MD, Massachusetts General Hospital, Diabetes Unit, Bulfinch 408, Fruit Street, Boston, MA 02114. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoInhaled Human Insulin Treatment in Patients with Type 2 Diabetes Mellitus William T. Cefalu , Jay S. Skyler , Ione A. Kourides , William H. Landschulz , Cecile C. Balagtas , Shu-Lin Cheng , Robert A. Gelfand , and Inhaled Insulin: A Proof-of-Concept Study William T. Cefalu Inhaled Insulin: A Proof-of-Concept Study William T. Cefalu Metrics Cited ByInsulin Therapy: Current AlternativesInhaled InsulinsInsulin therapy in type 2 diabetesEffective Insulin TherapyInhaled insulin – a new therapeutic option in the treatment of diabetes mellitusNovel Drug Delivery Systems for InsulinRecent Advances in the Development of an Inhaled Insulin ProductSmall steps, large problems: advances in the management of diabetes mellitusINSULIN THERAPY IN TYPE 2 DIABETESCommentaryThe type 2 diabetes epidemic: a hidden menacePharmaceutical Price Controls and Patient WelfareJohn E. Calfee, PhDInhaled Insulin: A Proof-of-Concept StudyWilliam T. Cefalu, MDInhaled insulin beneficial in type 2 diabetes? 6 February 2001Volume 134, Issue 3Page: 242-244KeywordsCellsGlucoseHemoglobinHypoglycemiaInsulinInsulin secretionLungsSafety studiesType 1 diabetesType 2 diabetes ePublished: 6 February 2001 Issue Published: 6 February 2001 CopyrightCopyright © 2001 by American College of Physicians. All Rights Reserved.PDF DownloadLoading ...