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Randomized Controlled Trial
. 2024 Sep 1;47(9):1682-1687.
doi: 10.2337/dc24-0838.

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  1 , Roy W Beck  2 , Martin Chase Marak  2 , Peter Calhoun  2 , Adham Mottalib  3 , Amna Salhin  4 , Anastasios Manessis  5 , Andrea D Coviello  6 , Anuj Bhargava  7 , Ashley Thorsell  8 , Astrid Atakov Castillo  9 , Bruce W Bode  10 , Camilla Levister  11 , Carol J Levy  11 , Cassandra Donahue  6 , Christian Cordero  12 , Christie Beatson  13 , Christine R Langel  7 , Christopher Jacobson  12 , Corey Kurek  14 , Dana Cruse  15 , David Pickering  15 , Denisa Tamarez  11 , Devin W Steenkamp  9 , Donna Desjardins  14 , Grazia Aleppo  16 , Grenye O'Malley  11 , Halis K Akturk  13 , Jamie Diner  6 , Jesica D Baran  1 , John B Buse  6 , Katrina Ruedy  2 , Kevin Codorniz  12 , Klara R Klein  6 , Kristin Castorino  8 , Lin Fan Jordan  17 , Mark Kipnes  4 , Mei Mei Church  8 , Osama Hamdy  3 , Philip Raskin  17 , Quang T Nguyen  18 , Ruth S Weinstock  19 , Scott Lee  12 , Shafaq Rizvi  14 , Suzan Bzdick  9 , Tahereh Ghorbani Rodriguez  6 , Tareq Salah  3 , Thomas Blevins  20 , Yogish C Kudva  14 , Zehra Haider  13 ; INHALE-3 Study Group
Collaborators, Affiliations
Randomized Controlled Trial

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 et al. Diabetes Care. .

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.

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Conflict of interest statement

Duality of Interest. I.B.H. reports consulting for Abbott, Roche, Hagar, and Vertex Pharmaceuticals and research support from MannKind, Dexcom, and Tandem Diabetes Care. R.W.B. reports no personal financial disclosures but reports that his institution has received funding on his behalf as follows: grant funding, study supplies, and consulting fees from Insulet, Tandem Diabetes Care, and Beta Bionics; grant funding and study supplies from Dexcom; grant funding from Bigfoot Biomedical; study supplies from Medtronic, Ascencia, and Roche; consulting fees and study supplies from Eli Lilly and Novo Nordisk; and consulting fees from embecta, Sequel Med Tech, Vertex Pharmaceuticals, Hagar, Ypsomed, Sanofi, and Zucara. A.D.C. reports consulting for Novo Nordisk, Intuitive Surgical, Inc., Hanmi-IQVIA, and Wellworksforyou, Inc. A.B. reports ongoing research grant support from the following: Boehringer Ingelheim Pharmaceuticals, Inc., Abbot Diabetes Care, AbbVie, Inc., Covance, Inc., Dexcom, Inc., Eli Lilly and Company, Madrigal Pharmaceuticals, Inc., Medtronic, Novo Nordisk, Carmot, Quintiles, Akero, 89 Bio, Inc., Viking Therapeutics, Barbara Davis Center for Diabetes, PPD, Zydus, Kowa Pharmaceuticals America, Inc., until October 2023, and Insulet Corporation until June 2022. A.T. receives supplies and research support provided to her institution from the following: Tandem Diabetes Care, Altimmune, Insulet, Dexcom, Medtronic, Eli Lilly, MannKind, Roche, and Abbott Diabetes Care. C.L. receives research support from Tandem Diabetes Care and Dexcom paid to her institution. C.J.L. reports research support paid to her institution from Dexcom, Tandem Diabetes Care Insulet, Novo Nordisk, and Abbott Diabetes and consulting fees from Dexcom and Tandem Diabetes Care. C.J. reports consulting for Medtronic advisory boards and speaking for Medtronic on insulin pumps. D.P. reports support from Novo Nordisk, Eli Lilly, MannKind, AstraZeneca, and Boehringer Ingelheim. D.W.S. reports consulting for Abbott Diabetes Care and research funding through his institution from the following: Abbott Diabetes Care, Tandem Diabetes Care, Novo Nordisk, and the National Institutes of Health/National Institute of Diabetes and Digestive and Kidney Diseases. G.M. reports research support from Dexcom, Abbot, Tandem Diabetes Care, Insulet, and Novo Nordisk. H.K.A. reports grant support received for his institution from Medtronic, Dexcom, and Tandem Diabetes Care and reports honorarium consulting from Medtronic, Dexcom, and Tandem Diabetes Care. J.B.B. reports grant support from Bayer, Boehringer-Ingelheim, Carmot, Corcept, Dexcom, Eli Lilly, Insulet, MannKind, Novo Nordisk, and vTv Therapeutics; consulting contracts from Alkahest, Altimmune, Anji, Aqua Medical, Inc., AstraZeneca, Boehringer-Ingelheim, CeQur, Corcept Therapeutics, Dasman Diabetes Care (Kuwait), Eli Lilly, embecta, Fortress Biotech, GentiBio, Glyscend, Insulet, Mediflix, Medscape, Mellitus Health, Metsera, Moderna, Novo Nordisk, Pendulum Therapeutics, Praetego, ReachMD, Stability Health, Tandem Diabetes Care, Terns, Inc., and Vertex Pharmaceuticals; expert witness engagement by Medtronic MiniMed; and stock options from Glyscend, Mellitus Health, Pendulum Therapeutics, Praetego, and Stability Health. K.R.K. has received consulting fees from Novo Nordisk. K.Ca. receives research support provided to her institution from Dexcom, Abbott, Medtronic, Eli Lilly, MannKind, and Insulet and receives consulting fees from Dexcom. M.K. reports acting on the clinical events committee for Tandem Diabetes Care; acting on the advisory board for Quest Diagnostics and Corcept; and research support from 89 Bio, Diamyd, Abbott, Akero, Kowa, Zydus, Biolinq, Corcept, Dexcom, Eli Lilly, Gilead, Insulet, Ionis, MannKind, Novo Nordisk, Pfizer, Reata, Inventiva, and Tandem Diabetes Care. O.H. reports consultant fees for Abbot Nutrition and receives research grants for his institution from Novo Nordisk, Eli Lilly, and Cambridge Technology. R.S.W. has participated in clinical trials, through her institution, sponsored by Tandem Diabetes Care, Insulet, Eli Lilly, Amgen, and Diasome and has received devices from Dexcom for clinical trials through her institution at a reduced cost. T.B. reports acting on a speaker bureau for Eli Lilly, Novo Nordisk, Sanofi, Boehringer-Ingelheim, AstraZeneca, and Dexcom; acting on the advisory board for Insulet and MannKind; and receiving research support form Eli Lilly, Novo Nordisk, Dexcom, Abbott, Medtronic, Tandem Diabetes Care, Biomea, and MannKind. Y.C.K. reports product support from Dexcom. No other potential conflicts of interest relevant to this article were reported.

Figures

None
Graphical abstract
Figure 1
Figure 1
Postprandial glucose excursion over 2 h. Results are shown for the overall group (A), the group on MDI or nonautomated pump (B), and the group using an AID system (C). Shaded areas represent 95% CI. Dotted lines represent the means.
Figure 2
Figure 2
Postprandial glucose excursion over 4 h. Results are shown for the overall group (A), the group on MDI or nonautomated pump (B), and the group using an AID system (C). Shaded areas represent 95% CI. Dotted lines represent the means.
See this image and copyright information in PMC

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