Inhaled Insulin - Why Isn’t It More Popular?
DOI:
https://doi.org/10.12775/QS.2026.75.75412Keywords
diabetes, glycemic control, insulin, side effectsAbstract
Background: Diabetes is a disease affecting an increasing number of patients each year. The medications currently available on the market are not perfect, which is why the search for new and more effective therapies continues. One such option is inhaled insulin, which, despite having been available on the market for nearly 20 years, is still not widely used. This raises the question: why is that?
Aim: A review of the available knowledge on inhaled insulins, including their advantages and disadvantages, as well as potential applications of this medication, with an attempt to answer the question of why they have not replaced subcutaneous insulins on the market.
Methods: A narrative review was conducted using the medical databases PubMed, Google Scholar, and ScienceDirect, identifying studies presenting various aspects of the use of inhaled insulins.
Results: The article presents the history of the introduction of inhaled insulins to the market, the reasons for their limited availability, their safety profile, positive and negative effects of therapy, and the potential use of this medication in the treatment of patients with diabetes.
Conclusion: The analyzed studies demonstrate a relatively high level of safety and efficacy of inhaled insulin therapy. They also highlight concerns and disadvantages associated with this form of treatment and suggest its potential role in the management of patients with diabetes.
References
1. Duncan BB, Magliano DJ, Boyko EJ. IDF Diabetes Atlas 11th edition 2025: global prevalence and projections for 2050. Nephrol Dial Transplant. 2025 Dec 23;41(1):7-9. doi: 10.1093/ndt/gfaf177. PMID: 40874767. https://doi.org/10.1093/ndt/gfaf177
2. Peyrot M, Rubin RR, Kruger DF, Travis LB. Correlates of insulin injection omission. Diabetes Care. 2010 Feb;33(2):240-5. doi: 10.2337/dc09-1348. PMID: 20103556; PMCID: PMC2809256. https://doi.org/10.2337/dc09-1348
3. Pettis RJ, Muchmore D, Heinemann L. Subcutaneous Insulin Administration: Sufficient Progress or Ongoing Need? J Diabetes Sci Technol. 2019 Jan;13(1):3-7. doi: 10.1177/1932296818817011. Epub 2018 Dec 7. PMID: 30522334; PMCID: PMC6313289. https://doi.org/10.1177/1932296818817011
4. Heinemann L, Baughman R, Boss A, Hompesch M. Pharmacokinetic and Pharmacodynamic Properties of a Novel Inhaled Insulin. J Diabetes Sci Technol. 2017 Jan;11(1):148-156. doi: 10.1177/1932296816658055. Epub 2016 Jul 9. PMID: 27378794; PMCID: PMC5375067. https://doi.org/10.1177/1932296816658055
5. Mitri J, Pittas AG. Inhaled insulin--what went wrong. Nat Clin Pract Endocrinol Metab. 2009 Jan;5(1):24-5. doi: 10.1038/ncpendmet1007. Epub 2008 Nov 4. PMID: 18981990; PMCID: PMC4042087. https://doi.org/10.1038/ncpendmet1007
6. Bruce W. Bode, Janet B. McGill, Daniel L. Lorber, Jorge L. Gross, P.-C. Chang, David B. Bregman, for the Affinity 1 Study Group; Inhaled Technosphere Insulin Compared With Injected Prandial Insulin in Type 1 Diabetes: A Randomized 24-Week Trial. Diabetes Care 1 December 2015; 38 (12): 2266–2273. https://doi.org/10.2337/dc15-0075
7. Shah RB, Patel M, Maahs DM, Shah VN. Insulin delivery methods: Past, present and future. Int J Pharm Investig. 2016 Jan-Mar;6(1):1-9. doi: 10.4103/2230-973X.176456. PMID: 27014614; PMCID: PMC4787057. https://doi.org/10.4103/2230-973X.176456
8. Santos Cavaiola T, Edelman S. Inhaled insulin: a breath of fresh air? A review of inhaled insulin. Clin Ther. 2014 Aug 1;36(8):1275-89. doi: 10.1016/j.clinthera.2014.06.025. Epub 2014 Jul 17. PMID: 25044021. https://doi.org/10.1016/j.clinthera.2014.06.025
9. Goldberg T, Wong E. Afrezza (Insulin Human) Inhalation Powder: A New Inhaled Insulin for the Management of Type 1 or Type-2 Diabetes Mellitus. P T. 2015 Nov;40(11):735-41. PMID: 26609206; PMCID: PMC4634344.
10. Shahani S, Shahani L. Use of insulin in diabetes: a century of treatment. Hong Kong Med J. 2015 Dec;21(6):553-9. doi: 10.12809/hkmj154557. Epub 2015 Nov 6. PMID: 26554270. https://doi.org/10.12809/hkmj154557
11. Kaiserman KB, Christiansen M, Bhavsar S, Ulloa J, Santogatta B, Hanna J, Bailey TS. Reduction in Postprandial Peak Glucose With Increased Technosphere Insulin Dosage. J Diabetes Sci Technol. 2024 Mar;18(2):397-401. doi: 10.1177/19322968221110622. Epub 2022 Jul 14. PMID: 35833638; PMCID: PMC10973860. https://doi.org/10.1177/19322968221110622
12. Seaquist ER, Blonde L, McGill JB, Heller SR, Kendall DM, Bumpass JB, Pompilio FM, Grant ML. Hypoglycaemia is reduced with use of inhaled Technosphere® Insulin relative to insulin aspart in type 1 diabetes mellitus. Diabet Med. 2020 May;37(5):752-759. doi: 10.1111/dme.14202. Epub 2019 Dec 19. PMID: 31811662; PMCID: PMC7216876. https://doi.org/10.1111/dme.14202
13. Galderisi A, Cohen N, Calhoun P, Kraemer K, Breton M, Weinzimer S, Cengiz E. Effect of Afrezza on Glucose Dynamics During HCL Treatment. Diabetes Care. 2020 Sep;43(9):2146-2152. doi: 10.2337/dc20-0091. Epub 2020 Jul 13. PMID: 32661108; PMCID: PMC7440894. https://doi.org/10.2337/dc20-0091
14. Akturk HK, Snell-Bergeon JK, Rewers A, Klaff LJ, Bode BW, Peters AL, Bailey TS, Garg SK. Improved Postprandial Glucose with Inhaled Technosphere Insulin Compared with Insulin Aspart in Patients with Type 1 Diabetes on Multiple Daily Injections: The STAT Study. Diabetes Technol Ther. 2018 Oct;20(10):639-647. doi: 10.1089/dia.2018.0200. Epub 2018 Sep 15. PMID: 30207748; PMCID: PMC6161328. https://doi.org/10.1089/dia.2018.0200
15. Levin PA, Heinemann L, Boss A, Rosenblit PD. Impact of symptomatic upper respiratory tract infections on insulin absorption and action of Technosphere inhaled insulin. BMJ Open Diabetes Res Care. 2016 Aug 25;4(1):e000228. doi: 10.1136/bmjdrc-2016-000228. PMID: 27648286; PMCID: PMC5013402. https://doi.org/10.1136/bmjdrc-2016-000228
16. Fountaine R, Milton A, Checchio T, Wei G, Stolar M, Teeter J, Jaeger R, Fryburg D. Acute passive cigarette smoke exposure and inhaled human insulin (Exubera) pharmacokinetics. Br J Clin Pharmacol. 2008 Jun;65(6):864-70. doi: 10.1111/j.1365-2125.2008.03122.x. PMID: 18477263; PMCID: PMC2485222. https://doi.org/10.1111/j.1365-2125.2008.03122.x
17. Pan AX, de la Peña A, Yeo KP, Chan C, Loh MT, Wise SD, Silverman BL, Muchmore DB. Effects of smoking cessation, acute re-exposure and nicotine replacement in smokers on AIR inhaled insulin pharmacokinetics and glucodynamics. Br J Clin Pharmacol. 2008 Apr;65(4):480-7. doi: 10.1111/j.1365-2125.2007.03041.x. Epub 2007 Oct 8. PMID: 17922880; PMCID: PMC2291373. https://doi.org/10.1111/j.1365-2125.2007.03041.x
18. Haller MJ, Kanapka L, Monzavi R, Mouse TJ, Prakasam G, Dewan AK, DiMeglio LA, Laffel LM, Willi SM, Tansey MJ, Nelson BA, Kashmiri H, Wood JR, Latif K, White P, Kipnes M, Rodriguez H, Smith J, Sparling DP, Malik FS, Cymbaluk A, Bhargava A, Ekhlaspour L, Beasley S, Cossen K, Wintergerst KA, Fiallo-Scharer R, Maahs DM, Bethin KE, Wood MA, Hanley PC, Mulukutla SN, Van Name M, Blackman SM, Gallagher MP, Clements MA, Sheanon N, Reddy K, Reiner BJ, Gal R, Beck RW; INHALE-1 Study Group*. INHALE-1: A Multicenter Randomized Trial of Inhaled Technosphere Insulin in Children With Type 1 Diabetes. Diabetes Care. 2026 Jan 1;49(1):179-187. doi: 10.2337/dc25-1994. PMID: 41223151; PMCID: PMC12818954. https://doi.org/10.2337/dc25-1994
19. Haller MJ, Jones MC, Bhavsar S, Kaiserman KB. Time-Action Profile of Technosphere Insulin in Children with Type 1 Diabetes. Diabetes Ther. 2023 Mar;14(3):611-617. doi: 10.1007/s13300-023-01368-7. Epub 2023 Jan 18. PMID: 36652106; PMCID: PMC9981820. https://doi.org/10.1007/s13300-023-01368-7
20. Petersen AH, Köhler G, Korsatko S, Wutte A, Wonisch M, Mautner A, Rønn BB, Clauson P, Laursen T, Wollmer P, Pieber TR. The effect of exercise on the absorption of inhaled human insulin in healthy volunteers. Br J Clin Pharmacol. 2008 Feb;65(2):165-71. doi: 10.1111/j.1365-2125.2007.03000.x. Epub 2007 Aug 31. PMID: 17764475; PMCID: PMC2291224. https://doi.org/10.1111/j.1365-2125.2007.03000.x
21. Rubin RR, Peyrot M. Psychometric properties of an instrument for assessing the experience of patients treated with inhaled insulin: the inhaled insulin treatment questionnaire (IITQ). Health Qual Life Outcomes. 2010 Mar 24;8:32. doi: 10.1186/1477-7525-8-32. PMID: 20334647; PMCID: PMC2856530. https://doi.org/10.1186/1477-7525-8-32
22. Peyrot M, Rubin RR. Perceived medication benefits and their association with interest in using inhaled insulin in type 2 diabetes: a model of patients' cognitive framework. Patient Prefer Adherence. 2011;5:255-65. doi: 10.2147/PPA.S18799. Epub 2011 Jun 7. PMID: 21792298; PMCID: PMC3140308.
23. Mikhail N. Place of technosphere inhaled insulin in treatment of diabetes. World J Diabetes. 2016 Dec 15;7(20):599-604. doi: 10.4239/wjd.v7.i20.599. PMID: 28031777; PMCID: PMC5155233. https://doi.org/10.4239/wjd.v7.i20.599
Materials from the Internet
1. Full prescribing information of Afrezza https://afrezza.com/pdf/full-prescribing-information
2. MannKind Corporation - Annual Report 2025 https://investors.mannkindcorp.com/static-files/540810df-764f-40d7-9907-15c09505c5f2
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