Hollander Priscilla A
Baylor University Medical Center, Endocrinology Center, Dallas, Texas, USA.
MedGenMed. 2007 Mar 5;9(1):45.
Many patients with diabetes fail to meet recommended glycemic goals regardless of the recognition of optimal glycemic control as a key component for improving clinical outcomes and quality of life in patients with diabetes. Patient- and physician-related barriers to the adoption of insulin therapy include fear and anxiety about injecting insulin, concerns about side effects, and personal health beliefs in regard to the use of insulin. There is an unmet need for an alternative insulin therapy that provides optimal glycemic control, is well tolerated, and improves patient adherence. Of the several inhaled insulin devices that are in various stages of development, the Exubera (INH) formulation is the first to be approved for use in the United States and in Europe. Exubera is a novel, rapid-acting inhaled human insulin formulation that has been developed for prandial insulin use. Clinical studies have shown that INH consistently improves glycemic control, in combination with longer-acting subcutaneous (SC) insulin regimens in patients with type 1 or type 2 diabetes, or is used to supplement or replace oral antidiabetic therapy in patients with type 2 diabetes. INH has demonstrated long-term safety and tolerability, with a risk for hypoglycemia similar to that of SC insulin, and no clinically meaningful changes in pulmonary function have been noted with its use. Patients treated with INH in clinical studies reported high levels of satisfaction with treatment, and many patients with diabetes choose inhaled insulin when it is offered as a treatment option. Taken together, these findings suggest that INH represents an important new development in the treatment of diabetes that may improve glycemic control in many patients with diabetes.
许多糖尿病患者未能达到推荐的血糖目标，尽管人们认识到最佳血糖控制是改善糖尿病患者临床结局和生活质量的关键组成部分。患者和医生方面与采用胰岛素治疗相关的障碍包括对注射胰岛素的恐惧和焦虑、对副作用的担忧以及关于胰岛素使用的个人健康观念。对于一种能提供最佳血糖控制、耐受性良好且能提高患者依从性的替代胰岛素疗法存在未满足的需求。在处于不同研发阶段的几种吸入式胰岛素装置中，Exubera（INH）制剂是首个在美国和欧洲获批使用的。Exubera是一种新型速效吸入式人胰岛素制剂，已被开发用于餐时胰岛素使用。临床研究表明，在1型或2型糖尿病患者中，INH与长效皮下（SC）胰岛素方案联合使用时能持续改善血糖控制，或者在2型糖尿病患者中用于补充或替代口服抗糖尿病治疗。INH已证明具有长期安全性和耐受性，低血糖风险与SC胰岛素相似，使用时未观察到肺功能有临床意义的变化。在临床研究中接受INH治疗的患者对治疗的满意度较高，并且当吸入式胰岛素作为一种治疗选择提供时，许多糖尿病患者会选择它。综上所述，这些发现表明INH代表了糖尿病治疗中的一项重要新进展，可能改善许多糖尿病患者的血糖控制。
