[Inhaled insulin--the breakthrough in the treatment of diabetes?]

Diabetes as a global epidemic is the fourth cause of death in the world currently. Ninety percent of all cases of diabetes represent patients with type 2 diabetes, in whom worsening of glycaemic control is observed with progression of the disease. A number of trials which have been conducted so far showed that lack of sufficient glycaemic control in both type 1 and type 2 diabetic patients accelerates progression of late complications of the disease. Although targets how to treat diabetes have been clearly defined few patients achieve them and maintain optimal metabolic control. Administration of insulin in type 1 diabetes is crucial for survival of the patients. Because of progressive course of the disease insulin is not rarely the only tool to achieve full normalization of glycaemia in type 2 diabetic patients. Chronic hyperglycemia in type 2 diabetic patients is the main reason to start insulin therapy. Decision about insulin administration is usually associated with patient's confusion and fear, mainly because of multiple subcutanoeus injections and risk of hypoglycaemia or secondary weight gain. Studies on inhaled insulin have been successfully completed recently. In the spring of 2005 Exubera, the first insulin inhaler, has been registered. The aim of this overview is to present the current clinical data on Exubera in treatment of patients with type 1 and 2 diabetes.