Inhaled Insulin Decoded: Dispelling Myths and Presenting Clinical Evidence

Despite advancements in prandial insulin therapeutics, real-world usage of these products is associated with challenges such as injection-related anxiety, an increased risk of hypoglycemia, and weight gain. Other factors contributing to insulin non-adherence include travel-related storage issues, public embarrassment related to administration, and busy schedules. In India, where postprandial hyperglycemia remains a concern, there is a need for effective and patient-friendly strategies to manage glycemia adequately. Afrezza® (MannKind Corporation, Danbury, CT, USA), an inhaled Technosphere® insulin, provides a non-invasive, needle-free approach that has a rapid onset of action and short duration of action and has been demonstrated to closely mimic the physiological insulin profile. Afrezza® is a dry powder recombinant human insulin formulation adsorbed onto a proprietary carrier, developed for the delivery of insulin deep into the alveoli of the lungs, where it is absorbed into the systemic circulation. This review seeks to clarify the clinical role of inhaled insulin by addressing common myths associated with its usage and presenting evidence-based insights on its pharmacokinetic (PK) and pharmacodynamic (PD) profile, efficacy and safety, pulmonary safety, dosing considerations, storage requirements, use in special populations, and contraindications. The review also discusses practical aspects of Afrezza® use, especially proper patient screening based on spirometry testing, patient education, and counseling. Ultimately, Afrezza® signifies a transformation in insulin therapy, offering an effective and convenient alternative to prandial insulin for adult patients with type 1 diabetes mellitus (T1DM) or type 2 diabetes mellitus (T2DM).