Monday, January 30, 2006

Winds of Change?

And so a new era begins.
Good or bad, it's too early to tell. The way these things go, it'll be good for the next 2 years, at least, before the bubble pops, if at all.
Exubera.
The world's first inhaled insulin. A revolutionary step in a revolutionary new direction. Insulin has been injectable since it was first introduced to the market after its discovery in 1922. No doubt, many new formulations have been created since, including the new ultra-long and short-acting analogues. But the dream was always to create a more convenient method of administration.
Researchers weren't able to overcome the issue of gastric acidity to develop ingested insulin. So this was the next logical step. Studies have shown this to be at least as efficacious as NPH insulin in type 1 and 2 diabetes. However, although the safety profile appeared to be similar, many like myself are nervous about how airway disease affects systemic absorption and how the aerosol may affect the respiratory tract in the longterm. Also, because inhaled insulin delivers such a high concentration of insulin into the body, many endocrinologists are nervous about the body may react to this after chronic exposure. Indeed, earlier studies have shown a much greater insulin antibody percent binding, 29% compared to 3% in subcutaneous insulin although the original article in Diabetes Care November 2004 stated:
"... was not associated with any clinically significant findings..."
But that's what they all say. Inadequate time for side effects to be obvious.
I'm sure my patients will start asking me about this soon. I'm not sure if I'll be starting anyone on this though, at least not in the first 6 months. Also, one thing people don't realize is that this just takes the place of their short-acting insulin, and not the basal.
But damn, maybe I should have bought stock in those companies producing it.

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