Advances in treating diabetes with aerosolized insulin.

DIABETES IS A DISEASE that affects approximately 16 million people in the United States. The majority of these people have non– insulin-dependent diabetes mellitus (NIDDM), or type 2 diabetes. Initially, their diabetes can be controlled with oral hypoglycemic drugs, change in diet, and exercise. However, as their disease progresses, they require the injection of insulin to control their glucose levels. Approximately 1 million people in the United States have insulin-dependent diabetes mellitus (IDDM), or type 1 diabetes. They require injections of insulin for glycemic control from the time of diagnosis. It is now recommended that patients who require insulin to treat their disease self-inject three or more times each day for optimal glucose control.1 Thus, there is a large population of diabetics who require, or will require, insulin by injection at some point in their lives. Because injection of insulin is associated with pain and a disruption of life-style, patient compliance with this treatment regimen is often compromised, leading to potentially suboptimal treatment outcomes. There is no pain with inhalational therapy, so it is not surprising that, beginning in the 1920s, a number of investigators have examined the possibility of administering aerosolized insulin as an alternative to injection. INTRAPULMONARY DELIVERY OF INSULIN AEROSOL