Inhaled insulin holds promise as a management option for patients with type 2 diabetes in whom dual oral therapy (an insulin secretagogue and an insulin sensitiser) is insufficient for glycaemic control. A North American study randomised 309 such patients to receive: inhaled insulin alone (n = 104); inhaled insulin in addition to oral therapy (n = 103); or, to maintain their oral therapy (n = 99). Patients randomised to receive inhaled insulin took it as an aerosolised powder just before meals; the dose was titrated to blood glucose levels. The combination therapy with inhaled insulin was more effective than monotherapy in reducing HbA1c levels after 12 weeks of treatment; both were more effective than usual treatment. Reported side-effects of inhaled insulin included hypoglycaemia, mild weight gain, and mild cough. Inhaled insulin has a faster onset of action than injected rapid-onset insulin, and its effect lasts for 4 to 6 hours.
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