Health
For diabetes patients, inhaled insulin is shown just as effective as injections and pumps
Most of the 38 million people living with diabetes in the U.S. use daily injections or insulin pumps to keep glucose at safe levels — but new research suggests that a third option could be just as effective.
In a study led by Dr. Irl B. Hirsch, M.D., medical director of the Diabetes Care Center of the University of Washington Medical Center, an inhaled form of insulin — similar to an asthma inhaler — worked just as well as injections or pumps to control type 1 diabetes.
The research was presented last week at the American Diabetes Association (ADA)’s 84th Scientific Sessions in Orlando, Florida.
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The clinical trial tested a product called Afrezza, an inhaled insulin made by MannKind Corporation in California.
Afrezza, the only inhaled insulin on the market, has been available since getting FDA approval in June 2014.
Benefits of a third option
“In those with type 1 diabetes, insulin is required for survival,” Hirsch told Fox News Digital in an interview.
“With continuous glucose sensing, glucose control has been dramatically improved — but not everyone reaches the target with multiple injections or pumps, and there are many pros and cons with each therapy,” he said.
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With pumps, people must wear the device, which can lead to skin problems.
They also have to purchase extra accessories.
Blood glucose levels can also drop with exercise, Hirsch warned, which can be problematic.
“Injections overall can be more convenient for some, but they don’t do as well as pump patients,” he said.
With Afrezza, the product is inhaled into the lungs before meals, and the fast-acting insulin minimizes the glucose spike often seen after eating, Hirsch noted.
“Patients with type 1 diabetes should consider this as another option for their mealtime insulin, and talk to their doctor about this choice.”
During the 17-week study, researchers evaluated the results of 141 adults who were assigned to either use the Afrezza inhaler or continue with traditional methods of injection or pump delivery.
At the 17-week mark, all participants switched to the inhaler for another 13 weeks.
All groups were assessed with continuous glucose monitoring at the start of the study, at 17 weeks and again at 30 weeks.
Among the inhaled insulin group, 30% of participants reached their target glucose levels (less than 7% blood sugar) compared to 17% of the people using injections and pumps.
There was no difference in hypoglycemia (low blood sugar) between the groups.
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“In general, there was no difference in our primary endpoint, HbA1c, a reflection of average blood sugar,” Hirsch said.
“But that alone is misleading — many patients did better with their glucose control, while others did worse.”
“The point is, inhaling insulin isn’t for everyone, but some did better than they did on their pumps.”
The people who saw the best results inhaled insulin between meals and at bedtime, Hirsch added.
At the end of the study, more than half of the participants said they would opt to stay on the inhaled insulin therapy.
“The biggest takeaway is that patients with type 1 diabetes should consider this as another option for their mealtime insulin, and talk to their doctor about this choice,” he recommended.
‘Adds value’
The American Diabetes Association acknowledged the promise of the study findings in an email to Fox News Digital.
“We look forward to our Scientific Sessions every year to see data like the INHALE-3 study’s findings, which have the potential to expand diabetes care,” Raveendhara Bannuru, M.D., PhD, the ADA’s vice president of medical affairs and quality improvement outcomes in Boston, Massachusetts, told Fox News Digital via email.
“We are hopeful for the continuous development of alternative insulin delivery methods that could offer options for people living with diabetes,” the group also said in the statement.
“The INHALE-3 trial demonstrated that inhaled insulin, combined with insulin degludec, effectively reduces A1c levels without increasing hypoglycemia or weight gain in people with type 1 diabetes. This adds value to the options in insulin therapy.”
Potential risks and limitations
While more people met their glycemic targets with Afrezza, some subjects saw worse readings when switching from usual methods to inhaled insulin — “potentially due to missing doses of inhaled insulin during the day and/or underdosing going into bedtime,” the researchers wrote.
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“We didn’t see any concerns,” Hirsch said when asked about side effects.
“As expected, a few people coughed immediately when dosing their insulin, but no major concerns were seen and everyone continued on their inhaled insulin.”
The most common side effects noted in the study were hypoglycemia, cough and throat pain or irritation.
Afrezza has been linked to a risk of acute bronchospasm in patients with chronic lung disease, such as asthma or COPD, according to the manufacturer.
“Inhaling insulin isn’t for everyone, but some did better than they did on their pumps.”
Before starting Afrezza, patients should see a doctor for a physical examination and testing to measure lung function.
Patients who smoke or who recently quit smoking should not take the inhaled medication.
For more Health articles, visit www.foxnews/health
Fox News Digital reached out to MannKind requesting additional comment.
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Health
One state leads country in human bird flu with nearly 40 confirmed cases
A child in California is presumed to have H5N1 bird flu, according to the San Francisco Department of Public Health (SFDPH).
As of Dec. 23, there had been 36 confirmed human cases of bird flu in the state, according to the California Department of Public Health (CDPH).
This represents more than half of the human cases in the country.
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The latest pediatric patient, who lives in San Francisco, experienced fever and conjunctivitis (pink eye) as a result of the infection.
The unnamed patient was not hospitalized and has fully recovered, according to the SFDPH.
The child tested positive for bird flu at the SFDPH Public Health Laboratory. The U.S. Centers for Disease Control and Prevention (CDC) will perform additional tests to confirm the result.
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It is not yet known how the child was exposed to the virus and an investigation is ongoing.
“I want to assure everyone in our city that the risk to the general public is low, and there is no current evidence that the virus can be transmitted between people,” said Dr. Grant Colfax, director of health, in the press release.
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“We will continue to investigate this presumptive case, and I am urging all San Franciscans to avoid direct contact with sick or dead birds, especially wild birds and poultry. Also, please avoid unpasteurized dairy products.”
Samuel Scarpino, director of AI and life sciences and professor of health sciences at Northeastern University in Boston, is calling for “decisive action” to protect individuals who may be in contact with infected livestock and also to alert the public about the risks associated with wild birds and infected backyard flocks.
“While I agree that the risk to the broader public remains low, we continue to see signs of escalating risk associated with this outbreak,” he told Fox News Digital.
Experts have warned that the possibility of mutations in the virus could enable person-to-person transmission.
“While the H5N1 virus is currently thought to only transmit from animals to humans, multiple mutations that can enhance human-to-human transmission have been observed in the severely sick American,” Dr. Jacob Glanville, CEO of Centivax, a San Francisco biotechnology company, told Fox News Digital.
“This highlights the requirement for vigilance and preparation in the event that additional mutations create a human-transmissible pandemic strain.”
As of Jan. 10, there have been a total of 707 infected cattle in California, per reports from the California Department of Food and Agriculture (CDFA).
For more Health articles, visit www.foxnews.com/health
In the last 30 days alone, the virus has been confirmed in 84 dairy farms in the state.
Health
Chronic Pain Afflicts Billions of People. It’s Time for a Revolution.
“In the beginning, everyone thought they were going to find this one breakthrough pain drug that would replace opioids,” Gereau said. Increasingly, though, it’s looking like chronic pain, like cancer, could end up having a range of genetic and cellular drivers that vary both by condition and by the particular makeup of the person experiencing it. “What we’re learning is that pain is not just one thing,” Gereau added. “It’s a thousand different things, all called ‘pain.’”
For patients, too, the landscape of chronic pain is wildly varied. Some people endure a miserable year of low-back pain, only to have it vanish for no clear reason. Others aren’t so lucky. A friend of a friend spent five years with extreme pain in his arm and face after roughhousing with his son. He had to stop working, couldn’t drive, couldn’t even ride in a car without a neck brace. His doctors prescribed endless medications: the maximum dose of gabapentin, plus duloxetine and others. At one point, he admitted himself to a psychiatric ward, because his pain was so bad that he’d become suicidal. There, he met other people who also became suicidal after years of living with terrible pain day in and day out.
The thing that makes chronic pain so awful is that it’s chronic: a grinding distress that never ends. For those with extreme pain, that’s easy to understand. But even less severe cases can be miserable. A pain rating of 3 or 4 out of 10 sounds mild, but having it almost all the time is grueling — and limiting. Unlike a broken arm, which gets better, or tendinitis, which hurts mostly in response to overuse, chronic pain makes your whole world shrink. It’s harder to work, and to exercise, and even to do the many smaller things that make life rewarding and rich.
It’s also lonely. When my arms first went crazy, I could barely function. But even after the worst had passed, I saw friends rarely; I still couldn’t drive more than a few minutes, or sit comfortably in a chair, and I felt guilty inviting people over when there wasn’t anything to do. As Christin Veasley, director and co-founder of the Chronic Pain Research Alliance, puts it: “With acute pain, medications, if you take them, they get you over a hump, and you go on your way. What people don’t realize is that when you have chronic pain, even if you’re also taking meds, you rarely feel like you were before. At best, they can reduce your pain, but usually don’t eliminate it.”
A cruel Catch-22 around chronic pain is that it often leads to anxiety and depression, both of which can make pain worse. That’s partly because focusing on a thing can reinforce it, but also because emotional states have physical effects. Both anxiety and depression are known to increase inflammation, which can also worsen pain. As a result, pain management often includes cognitive behavioral therapy, meditation practice or other coping skills. But while those tools are vital, it’s notoriously hard to reprogram our reactions. Our minds and bodies have evolved both to anticipate pain and to remember it, making it hard not to worry. And because chronic pain is so uncomfortable and isolating, it’s also depressing.
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