A Randomized Comparison of Postprandial Glucose Excursion Using Inhaled Insulin Versus Rapid-Acting Analog Insulin in Adults With Type 1 Diabetes Using Multiple Daily Injections of Insulin or Automated Insulin Delivery
Authors: Hirsch Irl B. , Beck Roy W. , Marak Martin Chase , Calhoun Peter , Mottalib Adham , Salhin Amna , Manessis Anastasios , Coviello Andrea D. , Bhargava Anuj , Thorsell Ashley , Atakov Castillo Astrid , Bode Bruce W. , Levister Camilla , Levy Carol J. , Donahue Cassandra , Cordero Christian , Beatson Christie , Langel Christine R. , Jacobson Christopher , Kurek Corey , Cruse Dana , Pickering David , Tamarez Denisa , Steenkamp Devin W. , Desjardins Donna , Aleppo Grazia , O’Malley Grenye , Akturk Halis K. , Diner Jamie , Baran Jesica D. , Buse John B. , Ruedy Katrina , Codorniz Kevin , Klein Klara R. , Castorino Kristin , Jordan Lin Fan , Kipnes Mark , Church Mei Mei , Hamdy Osama , Raskin Philip , Nguyen Quang T. , Weinstock Ruth S. , Lee Scott , Rizvi Shafaq , Bzdick Suzan , Ghorbani Rodriguez Tahereh , Salah Tareq , Blevins Thomas , Kudva Yogish C. , Haider Zehra ,   INHALE-3 Study Group, Bode Bruce W. , Ownby Jonathan , Johnson Joseph , Ruiz Adriana , Stephens Nashia , Maxson Amanda , Akturk Halis K. , Haider Zehra , Beatson Christie , Mason Emma , Steenkamp Devin W. , Wolpert Howard , Atakov-Castillo Astrid , Sullivan Asya , Kipnes Mark , Salhin Amna , Copple Tina , Beltran Stephanie , Ryan Terri , Levy Carol J. , O’Malley Grenye , Levister Camilla , Tamarez Denisa , Ipek Aslihan , Bhargava Anuj , Burke Christine , Langel Christine , Bauman Shannon , Haight Cristina , Bohr Allie , Hamdy Osama , Mottalib Adham , Salah Tareq , Al Badri Marwa , Dhaver Shilton , Nguyen Quang T. , Nguyen Loida , Codorniz Kevin , Lee Scott , Jacobson Christopher , Cordero Christian , Migliozzi Brittney , Kudva Yogish , Desjardins Donna , Reid Corey , Rizvi Shafaq , Kaur Ravinder Jeet , Livingood Daine , Pickering David , Cruse Dana , Aleppo Grazia , Kravarusic Jelena , Coyne Kasey , Herrmann Stefanie , Fronczyk Evelyn , Manessis Anastasios , McKillop Lorcan , Hyatt Jamie , Patruno Maria , Castorino Kristin , Church Mei Mei , Thorsell Ashley , Shuirman Maggie , Cobb Brandon , Watt Olivia , Weinstock Ruth , Bzdick Suzan , Blevins Thomas , Casaubon Luis , Espinosa Valerie , Pandit Keta , Perez Jennifer , Armstrong Chloe , Martinez-Arredondo Maritza , Stewart Ana , Johnson Olivia , Diner Jamie , Buse John , Klein Klara , Ghorbani Rodriguez Tahereh , Young Laura , Coviello Andrea D. , Donahue Cassandra , Kass Alexander , Fulghum Karla , Raskin Philip , Jordan Lin , Shao Baomei , Hirsch Irl B. , Baran Jesica , Mandava Patali , Holod Rosanna , Kaiserman Kevin , Ulloa Johanna , Pleitez Jennifer , Sylvan Joey , Badgett Lynn , Ruedy Katrina , Beck Roy , Borgman Sarah , Frey Sarah , Mba-Oduwusi Nnenna , Miller Paige , Fults Ashleigh , Marak Martin , Calhoun Peter , Pritchard Rosa , Dolzhenko Elizaveta , McCarthy Chris , Gabrielson Deanna , Brown Sue , Ahmann Andrew , Bergenstal Richard 
Published: July 2024

OBJECTIVE
To compare postprandial glucose excursions following a bolus with inhaled technosphere insulin (TI) or subcutaneous rapid-acting analog (RAA) insulin.

RESEARCH DESIGN AND METHODS
A meal challenge was completed by 122 adults with type 1 diabetes who were using multiple daily injections (MDI), a nonautomated pump, or automated insulin delivery (AID) and who were randomized to bolus with their usual RAA insulin (n = 61) or TI (n = 61).

RESULTS
The primary outcome, the treatment group difference in area under the curve for glucose &gt;180 mg/dL over 2 h, was less with TI versus RAA (adjusted difference −12 mg/dL, 95% CI −22 to −2, P = 0.02). With TI, the glucose excursion was smaller (P = 0.01), peak glucose lower (P = 0.01), and time to peak glucose shorter (P = 0.006). Blood glucose &lt;70 mg/dL occurred in one participant in each group.

CONCLUSIONS
Postmeal glucose excursion was smaller with TI than with RAA insulin in a cohort that included both AID and MDI users.