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Inhaled insulin arrives

Go-ahead for Exubera set to bring dramatic changes in diabetes care

GPs can expect dramatic changes ahead in their care of diabetes after the European Commission granted approval for an inhaled insulin.

Pfizer's Exubera will be available in the UK from May for the treatment of patients with type 2 diabetes who are inadequately controlled with oral agents and adults with type 1.

GPs hailed the development as an 'exciting breakthrough' which could lower the threshold for initiating insulin and help those with needle-phobia.

But they warned practices would face a heavy workload in assessing patients' suitability for the treatment and explaining the complex inhaler device.

Dr Neil Munro, a GP in Surrey and associate specialist in diabetes at the Chelsea and Westminster hospital, London, said: 'The diabetes population will be very excited by this development. Cost and newness will slow uptake to begin with, but there will be considerable pressure from patients for this.'

But he warned: 'The early delivery device is bulky and complex. Staff are likely to spend a bit of time explaining how insulin is delivered and how dose adjustment should occur.'

Dr Azhar Farooqi, a GP in Leicester and clinical lead for diabetes clinical governance at Eastern Leicester PCT, said: 'It will be an important new option for diabetics and is likely to lower the threshold for initiation of insulin and offer a real option to people who hate the idea of multiple injections. Ultimately it may even be an option for earlier therapy in type 2 diabetes.'

Exubera is a fast-acting insulin designed for use before meals and does not replace background insulin injections. Pfizer claims trials suggest it offers greater glycaemic control than injectables in patients poorly controlled on oral agents.

The new licence covers only adults. Inhaled insulin cannot be used in people with inadequate lung function or in smokers, since smoking greatly increases its absorption.

Dr Kevin Gruffydd-Jones, a member of the General Practice Airways Group and a GP in Box, Wiltshire, warned spirometry services would be stretched. 'For those who don't have spirometry it may be problematic.'

But he added: 'To have an inhaled method of delivery is an exciting breakthrough.'

NICE expects to issue guidance on NHS use of inhaled insulin in October.

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