Mikhail Nasser
Nasser Mikhail, Department of Medicine, OliveView-UCLA Medical Center, Sylmar, CA 91342, United States.
World J Diabetes. 2016 Dec 15;7(20):599-604. doi: 10.4239/wjd.v7.i20.599.
Technosphere insulin (TI), Afrezza, is a powder form of short-acting regular insulin taken by oral inhalation with meals. Action of TI peaks after approximately 40-60 min and lasts for 2-3 h. TI is slightly less effective than subcutaneous insulin aspart, with mean hemoglobin A1c (HbA1c) reduction of 0.21% and 0.4%, respectively. When compared with technosphere inhaled placebo, the decrease in HbA1c levels was 0.8% and 0.4% with TI and placebo, respectively. Compared with insulin aspart, TI is associated with lower risk of late post-prandial hypoglycemia and weight gain. Apart from hypoglycemia, cough is the most common adverse effect of TI reported by 24%-33% of patients 2% with insulin aspart. TI is contraindicated in patients with asthma and chronic obstructive pulmonary disease. While TI is an attractive option of prandial insulin, its use is limited by frequent occurrence of cough, need for periodic monitoring of pulmonary function, and lack of long-term safety data. Candidates for use of TI are patients having frequent hypoglycemia while using short-acting subcutaneous insulin, particularly late post-prandial hypoglycemia, patients with needle phobia, and those who cannot tolerate subcutaneous insulin due to skin reactions.
吸入型胰岛素（TI），即阿夫雷扎，是一种粉末状速效常规胰岛素，用餐时经口腔吸入。TI的作用在约40 - 60分钟后达到峰值，持续2 - 3小时。TI的效果略逊于皮下注射的门冬胰岛素，平均糖化血红蛋白（HbA1c）分别降低0.21%和0.4%。与吸入型安慰剂相比，TI和安慰剂使HbA1c水平分别降低0.8%和0.4%。与门冬胰岛素相比，TI发生餐后晚期低血糖和体重增加的风险较低。除低血糖外，咳嗽是TI最常见的不良反应，24% - 33%的患者有此症状，而门冬胰岛素患者中为2%。哮喘和慢性阻塞性肺疾病患者禁用TI。虽然TI是餐时胰岛素的一个有吸引力的选择，但其应用受到咳嗽频繁发生、需要定期监测肺功能以及缺乏长期安全性数据的限制。TI的适用人群为使用短效皮下胰岛素时频繁发生低血糖，尤其是餐后晚期低血糖的患者、有针头恐惧症的患者以及因皮肤反应无法耐受皮下胰岛素的患者。
