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Evidence-Based Medicine 2007;12:52; doi:10.1136/ebm.12.2.52
Copyright © 2007 by the BMJ Publishing Group Ltd.
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Therapuetics

Review: inhaled insulin provided better glycaemic control than oral hypoglycaemic agents but not subcutaneous insulin

Ceglia L, Lau J, Pittas AG. Meta-analysis: efficacy and safety of inhaled insulin therapy in adults with diabetes mellitus. Ann Intern Med 2006;145:665–75.[Abstract/Free Full Text]

Q In patients with diabetes, what is the relative efficacy, safety, and acceptability of inhaled insulin compared with subcutaneous (SC) insulin and oral hypoglycaemic agents?

Clinical impact ratings GP/FP/Primary care ******* IM/Ambulatory care ******{star} Endocrine *****{star}{star}

Key Words: diabetes mellitus (type 1) • diabetes mellitus (type 2) • hypoglycaemic agents • insulin

The first 150 words of the full text of this article appear below.

METHODS
Formula Data sources: Medline (to June 2006), Cochrane Controlled Clinical Trials Register (issue 2, 2006), reference lists, and the US Food and Drug Administration website.

Formula Study selection and assessment: randomised controlled trials (RCTs) of >=12 weeks’ duration that compared inhaled insulin with SC insulin or oral hypoglycaemic agents in non-pregnant adult patients with type 1 or type 2 diabetes. 16 RCTs (n = 4023, mean age range 29–60 y, 58% men) met the selection criteria. Methodological quality was assessed based on randomisation method, intention to treat analysis, dropout rate, and primary outcome (efficacy or safety).

Formula Outcomes: change in haemoglobin A1c (HbA1c) concentration, proportion of patients achieving HbA1c level <7%, severe hypoglycaemia, cough, change in pulmonary function, weight change, and patient satisfaction.

MAIN RESULTS
The table shows the results. Weight gain did not differ between inhaled and SC insulin (7 RCTs) but was higher with inhaled insulin than with combination oral therapy (3 . . . [Full text of this article]

Zubin Punthakee, MD, MSc

McMaster University, Hamilton, Ontario, Canada






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