The Pharmaceutical Journal
Vol 274 No 7347 p527
30 April 2005

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Diabetes UK annual professional conference

Inhaled insulin is effective and safe

Treatment with inhaled insulin is as effective as subcutaneous insulin treatment in patients with type 1 diabetes and is safe and effective in the long term, the results of a series of studies have demonstrated.

Although inhaled insulin is not yet licensed for use in the UK, Anthony Barnett, professor of medicine at the University of Birmingham and lead author of one of the studies, said that applications have been made to the European Medicines Agency and that he hoped the insulin inhaler, which is larger than traditional asthma inhalers, would be available within a year. The insulin inhaler would replace meal-time injections, enabling patients with diabetes to inject just once or twice a day.

Douglas Smallwood, Diabetes UK’s chief executive, said that after many attempts to come up with treatments to replace insulin injections, researchers now appeared close to success. “While it will not be suitable for everyone this could make a real difference to the daily lives of many people with diabetes,” he added.

A US study compared glycaemic control over 24 weeks in patients with type 1 diabetes using either a subcutaneous regimen or a regimen including an inhaled rapid-acting dry-powder.

The researchers found that comparable percentages of patients in both groups achieved HbA_1c levels lower than 7 per cent and 8 per cent.

A UK study in patients with type 2 diabetes showed that adjunctive inhaled insulin therapy was well tolerated for up to two years and that it provided significantly better glycaemic control than an additional oral agent in patients uncontrolled on oral monotherapy.

A further US study offered inhaled insulin to patients with diabetes who had completed a short-term trial of the treatment.

The researchers found that, in the 89 patients who took up the offer, both glycaemic control and lung function were well maintained after four years of treatment with inhaled insulin.

Pharmacists’ diabetes network needed

There needs to be a UK pharmacists’ diabetes network, the pharmacists’ professional discipline meeting decided.

Irene Gummerson, a community pharmacist in Wakefield, with a special interest in diabetes care, presented the proposal to the conference’s professional members’ meeting. She said that although only a handful of the 3,000 delegates at the conference were pharmacists, there was nonetheless a great deal of interest throughout the profession about diabetes care.

She argued that it was time, therefore, that a national network was established, through which hospital, community, academic and industry pharmacists could share ideas about innovative ways of working and advice about developing care plans for patients with diabetes.

Speaking to The Journal after the conference, Ms Gummerson said that the chief executive of Diabetes UK, Douglas Smallwood, told her that Diabetes UK would support the initiative.

Pharmacist-led clinics improve adherence in type 2 diabetes

Pharmacists can improve adherence to medication regimens and reduce blood pressure, weight and cholesterol levels, and improve diet and exercise levels in patients with type 2 diabetes, reviews of three pharmacist-led clinic programmes have demonstrated.

Pharmacists at the metabolic unit of the Western General Hospital, Edinburgh, reviewed the blood pressure, cardiovascular medication, lipid profiles, medication compliance and lifestyle of patients who had diabetes, cardiovascular disease or diabetic nephropathy and who were not meeting the Scottish Intercollegiate Guidelines Network cardiovascular risk targets.

Over 19 months 69 patients visited the clinic. On average, the patients’ systolic blood pressure was reduced by 35mmHg and diastolic by 16mmHg and their blood cholesterol levels fell by 0.6mmol/L. Patients reported improvements in their diet and exercise level and reductions in their smoking and alcohol consumption.

A retrospective review of a clinic at the Ulster Community and Hospital Trust, Belfast, showed that pharmacological and lifestyle management by pharmacists and nurses reduced cardiovascular risk in patients with type 2 diabetes.

The clinic reduced the weight of the 50 patients who attended by, on average, 1.8kg and their total cholesterol by an average of 0.65mmol/L.The researchers believe that the key to the success of the clinic in optimising drug and lifestyle therapy was its intensive approach to education and empowerment and its full involvement of patients.

Another clinic, at the diabetes centre, Stirling Royal Infirmary, used pharmacist prescribing guidelines to target blood pressure, lipids, antiplatelet and microalbumin therapy. Over five months, 96 patients attended the clinics.

The pharmacists’ interventions led to significant reductions in blood pressure (systolic by, on average, 10mmHg and diastolic by 7mmHg). The interventions also increased use of appropriate therapies (19 per cent increase for aspirin, 8 per cent for statins, 9 per cent for angiotensin-converting enzyme inhibitors and 20 per cent in the use of combined ACE-inhibitors and angiotensin receptor blockers). Before referral most patients were on appropriate drugs but received subtherapeutic doses. The researchers suggest that further improvements in management could be achieved by a move to supplementary prescribing by pharmacists.