Inhaled insulin may free children with type 1 diabetes from injections

Inhaled insulin helps to control blood sugar levels in children with type 1 diabetes as effectively as an injected version of the hormonal medication. The inhaled powder, called Afrezza, is already available for adults with type 1 or type 2 diabetes in the US, and now its manufacturers are planning to file for approval in children.

Type 1 diabetes occurs when the body can’t make the blood-sugar-lowering hormone insulin. People with the condition have to take insulin as a drug every day, usually via injections. But blood sugar levels can still be difficult to control, especially after meals, when they tend to spike, and after exercise, when they can fall.

Michael Haller at the University of Florida, who is on the advisory board of Afrezza, and his colleagues wondered if inhaled insulin, which can improve blood sugar control among adults by acting more quickly than injected insulin, also works in children. To find out, they recruited 230 people between the ages of 4 and 17. Most of the participants had type 1 diabetes, but a few had type 2 diabetes and required insulin to manage their condition.

All the children received basal insulin, which is injected once or twice a day to ensure there is a baseline low level of the hormone in the body at all times. Rapid-acting insulin is usually required on top of this before meals. In the 26-week trial, some of the children received Afrezza as their rapid-acting insulin, while others had injectable insulin.

The researchers found that both formulations worked equally well at controlling blood sugar levels. The results were presented at the American Diabetes Association meeting in Chicago in June.

“The assumption is that this is a better insulin because of the delivery method and certainly for some patients with a needle phobia, this can cause a lot of stress,” says Haller. “But more importantly, it gives patients additional tools in their toolbox for managing a very complex disease.”

The inhaled version caused coughing more than the injected one, but this dissipated once the participants got used to it. Afrezza is not suitable for anyone with long-term lung problems, like asthma.

Kathryn Sumpter at the The University of Tennessee Health Science Center in Memphis says that inhaled insulin may suit some children with diabetes, for example, those who forget to take the hormone before they eat and therefore need a particularly rapidly acting formula. But she thinks that most will probably stick to the injected formulation, which can be titrated much more precisely, so is especially helpful for small children, who may need lower amounts of insulin.

MannKind Corporation, the company that makes Afrezza, is planning to file for regulatory approval for its use in children in the US, says Haller.