Inhaled Technosphere Insulin Reduces Postmeal Glucose Excursion in Youth Living with Type 1 Diabetes

To assess postprandial glucose excursions following a meal bolus of inhaled technosphere insulin (TI) in youth with type 1 diabetes.

As part of a multicenter randomized controlled trial, 217 youth 4-17 years old with type 1 diabetes using multiple daily injections (MDI) completed an in-clinic standardized meal challenge with their first TI dose. Glucose levels were monitored for 2 h. Outcomes were compared with outcomes in MDI-using adults with T1D who received a TI (N = 51) or a rapid-acting analogue (RAA, N = 25) bolus for a similar meal challenge in a separate trial.

Following TI inhalation, the glucose excursion and glycemic metrics were similar in the pediatric cohort to those of the adult TI cohort. In contrast, compared with the adult RAA cohort, the pediatric TI cohort had a smaller glucose excursion (P < 0.001), lower peak glucose (P < 0.001), smaller AUC180 (P < 0.001), and higher time-in-range 70-180 mg/dL (P = 0.002). A glucose value < 70 mg/dL occurred in 14 (6%) of the pediatric TI cohort versus 1 (2%) of the adult TI cohort. Children 4-12 years old had a significantly higher peak glucose and excursion (P < 0.001) than those 13-17 years old. No significant difference in response to meal challenges was observed between groups with baseline HbA1c < 8.5% and HbA1c ≥ 8.5%. The mean ratio of TI inhaled units to the calculated RAA bolus that would be given for the number of carbohydrates was 1.9 ± 0.6 in the pediatric cohort and 1.9 ± 0.2 in the adult cohort.

In children with type 1 diabetes, the postmeal glucose excursion following a TI bolus was similar to the postmeal glucose excursion that occurs with TI in adults and significantly lower than the excursion that has been observed with RAA in adults. These findings are consistent with the known pharmacokinetic profile of TI.