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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

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Hirsch, Irl B., Beck, Roy W., Marak, Martin Chase, Calhoun, Peter, Mottalib, Adham, Salhin, Amna, Manessis, Anastasios, Coviello, Andrea D. +156 more·2024·Diabetes Care
DOI 10.2337/dc24-0838PMC PMC11362108
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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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  • In a recent randomized clinical trial, technosphere inhaled insulin showed lower postprandial hyperglycemia than subcutaneous rapid-acting analog insulin.

    “In a recent randomized clinical trial, the use of technosphere inhaled insulin showed lower postprandial hyperglycemia than subcutaneous rapid-acting analog insulin (152).”

    From 7. Diabetes Technology: Standards of Care in Diabetes—2025 (2025) · cites this paper as [152]

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Authors
Hirsch, I. B., Beck, R. W., Marak, M. C., Calhoun, P., Mottalib, A., Salhin, A., Manessis, A., Coviello, A. D., Bhargava, A., Thorsell, A., Atakov Castillo, A., Bode, B. W., Levister, C., Levy, C. J., Donahue, C., Cordero, C., Beatson, C., Langel, C. R., Jacobson, C., Kurek, C., Cruse, D., Pickering, D., Tamarez, D., Steenkamp, D. W., Desjardins, D., Aleppo, G., O’Malley, G., Akturk, H. K., Diner, J., Baran, J. D., Buse, J. B., Ruedy, K., Codorniz, K., Klein, K. R., Castorino, K., Jordan, L. F., Kipnes, M., Church, M. M., Hamdy, O., Raskin, P., Nguyen, Q. T., Weinstock, R. S., Lee, S., Rizvi, S., Bzdick, S., Ghorbani Rodriguez, T., Salah, T., Blevins, T., Kudva, Y. C., Haider, Z., INHALE-3 Study Group, Bode, B. W., Ownby, J., Johnson, J., Ruiz, A., Stephens, N., Maxson, A., Akturk, H. K., Haider, Z., Beatson, C., Mason, E., Steenkamp, D. W., Wolpert, H., Atakov-Castillo, A., Sullivan, A., Kipnes, M., Salhin, A., Copple, T., Beltran, S., Ryan, T., Levy, C. J., O’Malley, G., Levister, C., Tamarez, D., Ipek, A., Bhargava, A., Burke, C., Langel, C., Bauman, S., Haight, C., Bohr, A., Hamdy, O., Mottalib, A., Salah, T., Al Badri, M., Dhaver, S., Nguyen, Q. T., Nguyen, L., Codorniz, K., Lee, S., Jacobson, C., Cordero, C., Migliozzi, B., Kudva, Y., Desjardins, D., Reid, C., Rizvi, S., Kaur, R. J., Livingood, D., Pickering, D., Cruse, D., Aleppo, G., Kravarusic, J., Coyne, K., Herrmann, S., Fronczyk, E., Manessis, A., McKillop, L., Hyatt, J., Patruno, M., Castorino, K., Church, M. M., Thorsell, A., Shuirman, M., Cobb, B., Watt, O., Weinstock, R., Bzdick, S., Blevins, T., Casaubon, L., Espinosa, V., Pandit, K., Perez, J., Armstrong, C., Martinez-Arredondo, M., Stewart, A., Johnson, O., Diner, J., Buse, J., Klein, K., Ghorbani Rodriguez, T., Young, L., Coviello, A. D., Donahue, C., Kass, A., Fulghum, K., Raskin, P., Jordan, L., Shao, B., Hirsch, I. B., Baran, J., Mandava, P., Holod, R., Kaiserman, K., Ulloa, J., Pleitez, J., Sylvan, J., Badgett, L., Ruedy, K., Beck, R., Borgman, S., Frey, S., Mba-Oduwusi, N., Miller, P., Fults, A., Marak, M., Calhoun, P., Pritchard, R., Dolzhenko, E., McCarthy, C., Gabrielson, D., Brown, S., Ahmann, A., & Bergenstal, R.
Affiliations
  • 2JAEB Center for Health Research, Tampa, FL
  • Jaeb Center for Health Research (US)
  • 9Boston Medical Center, Boston, MA
  • 7Iowa Diabetes and Endocrinology Research Center, West Des Moines, IA
  • Mayo Clinic (US)
  • University of Washington (US)
  • 6University of North Carolina, Chapel Hill, NC
  • The University of Texas Southwestern Medical Center (US)
  • 19SUNY Upstate Medical University, Syracuse, NY
  • 14Mayo Clinic, Rochester, MN
ORCID
Venue
Diabetes Care
Publisher
American Diabetes Association
Published
2024-07-23
Volume
47
Issue
9
Pages
1682-1687
ISSN
  • 0149-5992 (ISSN-L)
  • 1935-5548
DOI
10.2337/dc24-0838
PMC
PMC11362108
OpenAlex
W4400912290
Cited by
33
References
3
Citations by year
2026: 18 · 2025: 13 · 2024: 2
FWCI
10.87
Type
journal article
Language
en
Open access
Licence
www.diabetesjournals.org/journals/pages/license (vor)
Locations
  • Diabetes Care (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • MannKind
  • Health Research Foundation, Inc.
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
Keywords
inhaled insulin, Technosphere insulin, rapid-acting insulin analogs, type 1 diabetes, postprandial glucose excursions, bolus insulin, multiple daily insulin injections, artificial pancreas, insulin pump therapy, hypoglycemia
MeSH terms
Administration, Inhalation, Adult, Blood Glucose, Diabetes Mellitus, Type 1, Female, Humans, Hypoglycemic Agents, Insulin, Insulin Infusion Systems, Male, Middle Aged, Postprandial Period, Insulin, Short-Acting

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