Unlocking the opportunity of tight glycaemic control. Promise ahead: the role of inhaled insulin in clinical practice.

The attainment and maintenance of good glycaemic control in both type 1 and type 2 diabetes are major challenges. The main (perceived) barriers of therapy are poor compliance with prescribed medication, hypoglycaemia, fear of insulin injection and fear of self-testing by finger pricking. Another major issue is the acceptance and uptake of new insulin-delivery systems and routes of administration. Insulin therapy regimens and insulin preparations are nowadays often chosen because of the ease of delivery. The use of inhaled insulin may, because of the relative ease of administration, facilitate the transfer of type 2 diabetes patients from tablets to insulin, especially in patients with fear or phobia of needles. However, non-injectable insulin will not automatically be preferred to subcutaneous (SC) insulin injections and a proper assessment of patient acceptance and preference is of great importance. Recent studies suggest that patients may prefer inhaled insulin (Exubera) over SC insulin. Thus, the availability of inhaled insulin as a potential treatment may increase a patient's willingness to add or change to more appropriate diabetes therapy, which includes insulin. Future studies should be targeted at specific groups of patients who may benefit the most from inhaled insulin, such as those with type 2 diabetes who are delaying initiation or intensification of insulin injections.