One Step Forward, One Step Back

Regarding the recent EU and FDA approvals for Exubera (insulin human [rDNA origin), Pfizer's version of Inhaled Insulin, here is my outlook:

1. Does it offer coverage for "Excellent Control"
By now the DCCT is a catch-word for how controlling diabetes leads to better outcomes. For any new product entering the Diabetes category this promise is mandatory/critical.

Unfortunately, there is no dosage precision with Inhaled Insulin ("The onset of Exubera is more rapid and its duration of action is similar to that of regular insulin.") Think back to a time before the pump, then go back a bit further to a time when injecting Regular insulin 30 minutes before a meal seemed a novel approach. (Early 1980's for me!) Exubera is packaged in single-dose blister packs of 1 or 3 mg (equivalent to 3 or 9 units of subcutaneous short-acting insulin, respectively).

Inhaled Insulin, in this regard is a step back for diabetes and precision self-management, and yet, a step-forward for mastering a whole new delivery approach that does not rely on injections. Hmmm...it occurs to me, we are just not there yet.

It is not all bad news, for some, Inhaled Insulin may be a complementary therapy to a T2 patient currently on once or twice-daily long-acting injectable insulins (Levemir or Lantus)who needs an additional lift to cover meals and post-prandial highs. It will be especially useful to those who cannot overcome the dreaded injections. Although, potential long-term pulmonary toxicity will have to be carefully monitored.

For me? Would I give up control close to par excellence with an insulin pump - No! But it won't be an option for anyone on the pump, and it certainly won't replace it.

Is Inhaled Insulin the new "Moses" product for diabetics today. Sadly no! Is it going to make billions for Pfizer and Nektar? Computer says no...