Recent News and Articles on the Keywords: nice + inhaled + insulin  Related to the article below (Last Update: 8/7/2008)

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NICE: inhaled Insulin is not recommended for the treatment of type 1 or type 2 diabetes mellitus ( preliminary recommendations )

The National Institute for Health and Clinical Excellence ( NICE ) has conducted an appraisal of inhaled Insulin for the treatment of diabetes ( types 1 and 2 ) and provide guidance on its use to the NHS in England and Wales.
The Committee has developed preliminary recommendations on the use of inhaled Insulin for the treatment of diabetes ( type 1 and 2 ).

The Appraisal Committee reviewed the data available on the clinical and cost effectiveness of inhaled Insulin for the treatment of diabetes ( types 1 and 2 ), having considered evidence on the nature of the condition and the value placed on the benefits of inhaled insulin by people with diabetes mellitus, those who represent them, and clinical experts. It was also mindful of the need to take account of the effective use of NHS resources.

The Committee sought the opinion of the clinical and patient experts about the likely level of need for inhaled Insulin in clinical practice.
The experts advised the Committee that using injected Insulin is not usually a concern for the majority of people with diabetes, given the availability of patient support and education, modern small needle types and insulin pens.
The experts also pointed out that the availability of inhaled insulin would not completely replace the need for injections of insulin for most people with diabetes, and that inhaled insulin might not fully alleviate any problems relating to true needle phobia, because individuals would still need to use needles for glucose testing.

However, the Committee understood that there were reasons why some individuals, who need to improve their glycaemic control, were reluctant either to start Insulin therapy or to intensify injection regimens.
For example, some people with type 2 diabetes are concerned about hypoglycaemic attacks, or believe that the move to Insulin injections represents a failure on their part with oral therapy, or think that the change in therapy indicates that their diabetes has become much worse.
Some people with diabetes may also be concerned about the impact of using insulin on their driving licence status and employment, but these concerns would be equally relevant with inhaled Insulin. The Committee also heard from the clinical and patient experts that a small group of people with diabetes are so averse to injections for psychological or cultural reasons that they would rather face the prospect of diabetic complications than use subcutaneous Insulin.

The Committee discussed the use of inhaled Insulin in people with type 1 diabetes, many of whom need to adjust their dosage on a day-to-day basis in order to achieve optimal control. It was pointed out by the patient experts that the inhaled Insulin device does not allow patients to adjust their Insulin dose sufficiently. This limitation may lead to difficulties in glucose control compared with injections.

The Committee considered the evidence on clinical effectiveness and was persuaded that inhaled Insulin can be regarded as effective in controlling HBA1c levels as short-acting subcutaneous insulin ( as used in the randomized clinical trials, RCTs ). However, concerns were raised regarding the methods of the reported RCTs, none of which compared inhaled Insulin with current standard care in the UK, which uses a range of alternative injection therapies including Insulin pens, Insulin analogues and Insulin glargine. The methods used limit the assessment of the generalisability of the results to routine clinical practice. In addition, none of the RCTs examined the effectiveness of inhaled Insulin exclusively in people whose blood glucose levels are uncontrolled on their current regimen.

The Committee also discussed the uncertainties regarding the long-term safety of inhaled Insulin in terms of potential pulmonary effects and the reported higher levels of insulin antibodies in people with type 1 diabetes.