Navigating Beyond Needles: The Inhaled Insulin Revolution and Its Impact on the Future of Insulin Therapy

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Published: 2024-02-13

Page: 48-57


Aaravula Hemanth Babu

Department of Pharmacology, Raghavendra Institute of Pharmaceutical Education and Research (RIPER) – Autonomous, KR PalliCross, Chiyyedu (Post), Anantapur, Andhra Pradesh, 515721, India.

Akula Ruchitha Sai

Department of Pharmacology, Raghavendra Institute of Pharmaceutical Education and Research (RIPER) – Autonomous, KR PalliCross, Chiyyedu (Post), Anantapur, Andhra Pradesh, 515721, India.

Mopuri Jyothsna

Department of Pharmacology, Raghavendra Institute of Pharmaceutical Education and Research (RIPER) – Autonomous, KR PalliCross, Chiyyedu (Post), Anantapur, Andhra Pradesh, 515721, India.

Kota Bakthabandhavi

Department of Pharmacology, Raghavendra Institute of Pharmaceutical Education and Research (RIPER) – Autonomous, KR PalliCross, Chiyyedu (Post), Anantapur, Andhra Pradesh, 515721, India.

K. Somasekhar Reddy

Department of Pharmacology, Raghavendra Institute of Pharmaceutical Education and Research (RIPER) – Autonomous, KR PalliCross, Chiyyedu (Post), Anantapur, Andhra Pradesh, 515721, India.

P. Praveen Kumar *

Department of Pharmacology, Raghavendra Institute of Pharmaceutical Education and Research (RIPER) – Autonomous, KR PalliCross, Chiyyedu (Post), Anantapur, Andhra Pradesh, 515721, India.

*Author to whom correspondence should be addressed.


Abstract

The selection of insulin administration methods is crucial for achieving ideal glycemic control in the dynamic arena of managing diabetes. This review article explores the complex landscape of insulin delivery techniques with an emphasis on inhaled insulin and subcutaneous injections, two widely used treatment modalities for diabetes. The best insulin administration technique is determined by a number of factors, including the type of diabetes being treated, patient preferences, and lifestyle factors. We provide a thorough investigation of a range of insulin administration methods, including conventional subcutaneous injections and the most recent developments in insulin administration systems including pens, pumps, and smart insulin devices. Our attention is now more narrowly focused on the cutting-edge field of insulin inhalers, which can deliver fast-acting insulin and prevent post-meal glucose increases. These inhalers provide a non-invasive, needle-free alternative that is especially appealing to people who have needle phobia and may significantly improve patient's quality of life. The pharmacokinetics of both subcutaneous injections and inhaled insulin are thoroughly examined in this work.  We explain the benefits and drawbacks of each methodology and examine how it affects patients from a range of patient demographics, including children, seniors, and those who are obese. Designing the most optimal insulin administration plan for each distinct patient subgroup is our objective.

Keywords: Bivoltine, Insulin pen, oval, insulin inhalers, dumbbell, subcutaneous insulin injection, cocoon size, dry powder inhalers, multivoltine, liquid aerosol inhalers, technosphere insulin inhalers, ultrasonic insulin inhalers, nasal insulin inhalers


How to Cite

Babu, Aaravula Hemanth, Akula Ruchitha Sai, Mopuri Jyothsna, Kota Bakthabandhavi, K. Somasekhar Reddy, and P. Praveen Kumar. 2024. “Navigating Beyond Needles: The Inhaled Insulin Revolution and Its Impact on the Future of Insulin Therapy”. Asian Journal of Advances in Research 7 (1):48-57. https://www.jasianresearch.com/index.php/AJOAIR/article/view/182.

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References

Hirsch L, Byron K, Gibney M. Intramuscular risk at insulin injection sites—measurement of the distance from skin to muscle and rationale for shorter-length needles for subcutaneous insulin therapy. Diabetes Technology & Therapeutics. 2014;16(12): 867-73.

Gualandi-Signorini A, Giorgi G. Insulin formulations-a review. European review for medical and pharmacological sciences. 2001;5:73-84.

Easa N, Alany RG, Carew M, Vangala A. A review of non-invasive insulin delivery systems for diabetes therapy in clinical trials over the past decade. Drug discovery today. 2019;24(2):440-51.

Sparre T, Hammershøy L, Steensgaard DB, Sturis J, Vikkelsøe P, Azzarello A. Factors Affecting Performance of Insulin Pen Injector Technology: A Narrative Review. Journal of Diabetes Science and Technology. 2023;17(2):290-301.

Alsaleh FM, Smith FJ, Keady S, Taylor KM. Insulin pumps: from inception to the present and toward the future. Journal of clinical pharmacy and therapeutics. 2010; 35(2):127-38.

Siekmeier R, Scheuch G. Inhaled insulin–does it become reality. J Physiol Pharmacol. 2008;59(Suppl 6):81-113.

Heise T, Brugger A, Cook C, Eckers U, Hutchcraft A, Nosek L, et al. PROMAXX® inhaled insulin: safe and efficacious administration with a commercially available dry powder inhaler. Diabetes, Obesity and Metabolism. 2009;11(5):455-9.

Donner T, Sarkar S. Insulin–pharmacology, therapeutic regimens, and principles of intensive insulin therapy. 2015.

Rashid J, Absar S, Nahar K, Gupta N, Ahsan F. Newer devices and improved formulations of inhaled insulin. Expert Opinion on Drug Delivery. 2015;12(6):917-28.

Gradon L, Sosnowski TR. Formation of particles for dry powder inhalers. Advanced Powder Technology. 2014;25(1):43-55.

Ashurst I, Malton A, Prime D, Sumby B. Latest advances in the development of dry powder inhalers. Pharmaceutical science & technology today. 2000;3(7):246-56.

Murnane D, Hutter V, Harang M. Pharmaceutical aerosols and pulmonary drug delivery. Aerosol Science: Technology and Applications. 2013:221-69.

Komalla V, Wong CYJ, Sibum I, Muellinger B, Nijdam W, Chaugule V, et al. Advances in soft mist inhalers. Expert Opinion on Drug Delivery. 2023:1-16.

Brunner G, Balent B, Ellmerer M, Schaupp L, Siebenhofer A, Jendle J, et al. Dose-response relation of liquid aerosol inhaled insulin in type I diabetic patients. Diabetologia. 2001;44:305-8.

Neumiller JJ, Campbell RK, Wood LD. A review of inhaled technosphere insulin. Annals of Pharmacotherapy. 2010;44(7-8):1231-9.

de Kruijf W, Ehrhardt C. Inhalation delivery of complex drugs—the next steps. Current opinion in pharmacology. 2017;36:52-7.

Averkiev A. Application of ultrasonic inhalers and spray heads structure and principles of operation for insulin delivery. Journal of Economics and Social Sciences. 2018(13):6.

Muntu CM, Avanti C, Hayun H, Surini S. Stability study of spray freeze-dried insulin dry powder formulations used for nose-to-brain delivery. Journal of Applied Pharmaceutical Science. 2023;13(10):225-37.

Heinemann L, Pfutzner A, Heise T. Alternative routes of administration as an approach to improve insulin therapy: update on dermal, oral, nasal and pulmonary insulin delivery. Current pharmaceutical design. 2001;7(14): 1327-51.

Raccah D, Bretzel RG, Owens D, Riddle M. When basal insulin therapy in type 2 diabetes mellitus is not enough—what next? Diabetes/Metabolism Research and Reviews. 2007;23(4):257-64.

Roach P. New insulin analogues and routes of delivery: pharmacodynamic and clinical considerations. Clinical pharmacokinetics. 2008;47:595-610.

Kesavadev J, Krishnan G, Benny N. Insulin Delivery: An Evolution in the Technology. The Diabetes Textbook: Clinical Principles, Patient Management and Public Health Issues: Springer; 2023. p. 1141-58.

Carvalho TC, McConville JT. The function and performance of aqueous aerosol devices for inhalation therapy. Journal of Pharmacy and Pharmacology. 2016;68(5): 556-78.

Klonoff DC. Afrezza inhaled insulin: the fastest-acting FDA-approved insulin on the market has favorable properties. SAGE Publications Sage CA: Los Angeles, CA. 2014;1071-3.

Cunningham SM, Tanner DA. A review: the prospect of inhaled insulin therapy via vibrating mesh technology to treat diabetes. International Journal of Environmental Research and Public Health. 2020;17(16):5795.

Arnolds S, Heise T. Inhaled insulin. Best practice & research Clinical endocrinology & metabolism. 2007;21(4):555-71.

Rostami AA. Computational modeling of aerosol deposition in respiratory tract: a review. Inhalation toxicology. 2009;21(4): 262-90.

Newman SP. Drug delivery to the lungs: Challenges and opportunities. Therapeutic delivery. 2017;8(8):647-61.

Kesavadev J, Saboo B, Krishna MB, Krishnan G. Evolution of insulin delivery devices: from syringes, pens, and pumps to DIY artificial pancreas. Diabetes Therapy. 2020;11(6):1251-69.

Danne T, Bangstad HJ, Deeb L, Jarosz‐Chobot P, Mungaie L, Saboo B, et al. Insulin treatment in children and adolescents with diabetes. Pediatric diabetes. 2014;15(S20):115-34.

Sam T. Developing drug administration devices for geriatric use. Developing Drug Products in an Aging Society: From Concept to Prescribing. 2016:403-46.

Kirkman MS, Briscoe VJ, Clark N, Florez H, Haas LB, Halter JB, et al. Diabetes in older adults. Diabetes care. 2012;35 (12):2650.

American Geriatrics Society Panel on the Pharmacological Management of Persistent Pain in Older Persons RwpfTAGSOaaiJAGS, –. Pharmacological management of persistent pain in older persons. Pain Medicine. 2009;10(6):1062-83.

Tay J, Thompson CH, Brinkworth GD. Glycemic variability: assessing glycemia differently and the implications for dietary management of diabetes. Annual Review of Nutrition. 2015;35:389-424.

Huang J, Yeung AM, Kerr D, Gentile S, Heinemann L, Al-Sofiani ME, et al. Lipohypertrophy and Insulin. An Old Dog that Needs New Tricks. Endocrine Practice. 2023.

Lareau SC, Hodder R. Teaching inhaler use in chronic obstructive pulmonary disease patients. Journal of the American Academy of Nurse Practitioners. 2012;24(2):113-20.

Ligthelm RJ, Kaiser M, Vora J, Yale JF. Insulin use in elderly adults: risk of hypoglycemia and strategies for care. Journal of the American Geriatrics Society. 2012;60(8):1564-70.

Gazmararian JA, Williams MV, Peel J, Baker DW. Health literacy and knowledge of chronic disease. Patient education and counseling. 2003;51(3):267-75.

Baryakova TH, Pogostin BH, Langer R, McHugh KJ. Overcoming barriers to patient adherence: the case for developing innovative drug delivery systems. Nature Reviews Drug Discovery. 2023;22(5):387-409.

Shashaj B, Busetto E, Sulli N. Benefits of a bolus calculator in pre‐and postprandial glycaemic control and meal flexibility of paediatric patients using continuous subcutaneous insulin infusion (CSII). Diabetic Medicine. 2008;25(9):1036-42.