Barnett Anthony H, Bellary Sri
University of Birmingham and Heart of England National Health Service Foundation Trust (Teaching), Birmingham, UK.
Vasc Health Risk Manag. 2007;3(1):83-91.
Inhaled human insulin (Exubera) is a rapid-acting regular human insulin administered by oral inhalation before meals. It provides a non-invasive alternative to multiple subcutaneous injections for the treatment of hyperglycemia in adult patients with type 1 and type 2 diabetes. Compared with subcutaneous rapid-acting insulin analogs, Exubera provides equivalent HbA1c control. As a monotherapy or in combination with oral agents, Exubera also provides greater glycemic control than oral agents alone, at least in patients with high levels of HbA1c. Exubera demonstrates improved patient satisfaction compared with subcutaneous insulin or oral agents alone. When offered as a treatment option together with standard treatments in uncontrolled patients naive to insulin, Exubera increases acceptance of insulin therapy three-fold compared with patients offered standard regimens only. Exubera is well tolerated in comparison to subcutaneous insulin, with a similar incidence of mild to moderate hypoglycemia. Although cough is a common adverse effect early in therapy, this leads to treatment discontinuations in less than 1% of patients. Despite an increased incidence of insulin antibodies compared with subcutaneous administration, and a consistent but minor impact on pulmonary function, long-term safety data of up to 4 years continue to support the safety profile of Exubera.
吸入型人胰岛素（依克那肽）是一种速效常规人胰岛素，于餐前通过口腔吸入给药。它为1型和2型糖尿病成年患者治疗高血糖提供了一种非侵入性的替代多次皮下注射的方法。与皮下注射速效胰岛素类似物相比，依克那肽能使糖化血红蛋白（HbA1c）得到同等程度的控制。作为单一疗法或与口服药物联合使用时，依克那肽在控制血糖方面也比单独使用口服药物效果更好，至少在HbA1c水平较高的患者中如此。与单独使用皮下胰岛素或口服药物相比，依克那肽能提高患者满意度。当作为一种治疗选择与胰岛素初治的未控制患者的标准治疗一起提供时，与仅接受标准治疗方案的患者相比，依克那肽能使胰岛素治疗的接受度提高三倍。与皮下胰岛素相比，依克那肽耐受性良好，轻度至中度低血糖的发生率相似。尽管咳嗽是治疗早期常见的不良反应，但导致不到1%的患者停药。尽管与皮下给药相比，胰岛素抗体的发生率有所增加，且对肺功能有持续但轻微的影响，但长达4年的长期安全性数据仍支持依克那肽的安全性。
