Exubera, the world’s only inhaled insulin diabetes treatment, has got Drug-Controller General of India approval and will hit the market later this month. Manufactuerd by Pfizer, an inhaling device and a month’s supply of the drug is expected to cost about Rs 6,000. Standard injectable insulin therapy costs between Rs 800 and Rs 1,200 a month, depending on the medicines used.
The fast-acting powdered insulin formulation has to be inhaled through the mouth before meals with a hand-held device. The DCGI has approved its use by people with insulin-dependent type-1 and type-2 diabetes.
The bad news is that not everyone on insulin injections can switch over to the less painful inhaled form. “Exubera only replaces short-acting insulin and has to be used in addition to long-acting insulin injections,” says Dr Anoop Misra, director and head, Department of Diabetes and Metabolism, Fortis Group of Hospitals. In other words, people taking two or more insulin injections a day — short-acting ones besides a long-acting one to control the 24-hour basal supply of insulin — can now inhale insulin while continuing to take the one long-acting injection every day. The inhaled form is more effective for achieving post-meal glucose targets, which is difficult to control.
Exubera’s advantage is that there are no needle pricks involved. “The inhaler is expected to help those who are reluctant to start or intensify insulin treatment because they don’t want to take injections every day,” says Misra.
Now for the disadvantages: apart from the higher cost, the inhaler is bulky — unlike the pen-sized injections — and hard to use with five-six steps involved in getting the drug to the main inhaler. Exubera also comes in different doses from standard insulin, making dose conversion complicated.
Of 35 million people with diabetes in India, 2 per cent have type-1 diabetes, in which insulin-producing cells in the pancreas have been destroyed. Type-1 diabetics need to inject insulin before meals to mimic the body’s natural insulin response to the rise in blood glucose after eating. Those with the more severe type-2 diabetes also need injectable insulin for tighter blood sugar control. Several studies have shown that in most Indian metros, between 11 and 16 per cent of the adult population over 30 years of age has diabetes.