Episode 327: 326. Should We Prescribe Inhaled Insulin? INHALE-3 TRIAL

INHALE-3, a randomized trial, 123patients with type 1 dm that compared the efficacy of an inhaled insulin regimen (Afrezza) plus degludec insulin (Tresiba®) against usual care over 17 weeks The study's primary endpoint was a change in HbA1c levels, a critical marker of long-term blood glucose control.  More participants using the inhaled insulin regimen experienced significant improvements in HbA1c levels compared to those on usual care.21% of those on inhaled insulin had an HbA1c improvement of greater than 0.5%, while only 5% of those with standard care.  21 – 5 that is an absolute difference of 16% (NNT of 6.25) And they found a bunch of things when they went back like more people with a1c >7 reached their goal—which was not their end point they just found it and like to talk about   inhaled insulin and degludec was not for everyone: and everyone is missing this—we know how many people had an improvement in their a1c by 0.5% but how many had a worsening??? well 26% of the patients in the inhaled insulin group had a worsening of HbA1c greater than 0.5%compared with only 3% with standard care. 26-3== 23 100/23== 4.3 NNH So out of 100 people that still have to give themselves insulinThis doesn’t remove insulinBut we now add inhaled insulin we should expect to see 16 people out of the 100 have a 0.5% improvement in their a1c at 4 monthsAnd we would expect to see 23 poeople have a 0.5% worsening in their A!C That math don’t math—people are excited about this and all I can say is maybe they are getting paid by the drug company maybe they don’t understand number needed to treat and number needed to harm but this makes no sense.