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INHALE-1: A Multicenter Randomized Trial of Inhaled Technosphere Insulin in Children With Type 1 Diabetes
Michael J Haller1, Lauren Kanapka2, Roshanak Monzavi3
1Department of Pediatrics, University of Florida, Gainesville, FL.
Insights
Inhaled technosphere insulin (TI) did not meet noninferiority for HbA1c in children with diabetes. However, TI was safe, improved treatment satisfaction, and reduced weight gain compared to rapid-acting analog insulin.
Area of Science:
- Pediatric Endocrinology
- Diabetes Management
- Pharmacology
Background:
- Type 1 diabetes is a chronic condition requiring lifelong insulin therapy.
- Optimizing insulin delivery methods is crucial for improving glycemic control and patient quality of life.
- Inhaled insulin presents a potential alternative to injectable insulin formulations.
Purpose of the Study:
- To assess the efficacy and safety of inhaled technosphere insulin (TI) compared to rapid-acting analog (RAA) insulin in pediatric patients with diabetes.
- To evaluate TI's impact on glycemic control, specifically HbA1c levels and time in range (TIR).
- To determine the safety profile of TI, including pulmonary function and adverse events.
Main Methods:
- A randomized controlled trial involving 230 youth (4-17 years) with type 1 diabetes.
- Participants were assigned to receive either TI or RAA insulin for 26 weeks, alongside basal insulin and continuous glucose monitoring (CGM).
- The primary outcome was the change in HbA1c, with noninferiority testing against a 0.4% margin.
Main Results:
- The primary analysis did not achieve noninferiority for HbA1c change between TI and RAA groups (P = 0.091).
- CGM-measured time in range (70-180 mg/dL) showed no significant difference between the groups (P = 0.38).
- The TI group reported higher treatment satisfaction (P = 0.004) and experienced less weight and BMI percentile gain (P = 0.009).
Conclusions:
- Inhaled technosphere insulin did not meet the noninferiority criteria for HbA1c in pediatric patients with diabetes.
- TI demonstrated a favorable safety profile over 26 weeks, with no adverse effects on pulmonary function.
- TI offers a potentially valuable treatment option for select pediatric patients with type 1 diabetes, enhancing satisfaction and mitigating weight gain.
Objective:
To evaluate inhaled technosphere insulin (TI) in children with diabetes.
Research Design And Methods:
A total of 230 youth 4-17 years old with type 1 (98%) or type 2 (2%) diabetes treated with multiple daily injections of insulin were randomly assigned 1:1 to TI or rapid-acting analog (RAA) insulin plus continuation of long-acting basal insulin and continuous glucose monitoring (CGM) for 26 weeks. The primary outcome was change in HbA1c, tested for noninferiority with margin of 0.4%.
Results:
In intent-to-treat analysis, mean HbA1c (% ± SD) was 8.22 ± 0.87 at baseline and 8.41 ± 1.38 at 26 weeks with TI and 8.21 ± 0.96 and 8.21 ± 1.10, respectively, with RAA (adjusted difference = 0.18; 95% CI -0.07, 0.43; noninferiority P = 0.091). CGM-measured time in range 70-180 mg/dL was not significantly different between groups (adjusted difference -2.2%; 95% CI -7.0, 2.7; P = 0.38). Two severe hypoglycemic events occurred in the TI group and one in the RAA group. Change in forced expiration volume in 1 s from baseline to 26 weeks did not differ comparing TI and RAA (P = 0.53). The TI group reported greater treatment satisfaction (P = 0.004) and had less gain in weight and BMI percentile (P = 0.009) than did the RAA group.
Conclusions:
The primary analysis did not meet the prespecified criteria for HbA1c noninferiority. However, TI use was safe over 26 weeks without affecting pulmonary function and was associated with greater treatment satisfaction and less weight gain compared with RAA, supporting TI as a treatment option for some pediatric patients with type 1 diabetes.
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