The inexorable progression of type 2 diabetes frequently leads patients to need insulin replacement. Many
barriers exist to starting insulin therapy, including reluctance of patients to accept lifelong injections.
Inhalation of insulin has been suggested for many years, and recent advances in technology made this
method a reality. Exubera was the first inhalable insulin product to launch, and several other inhaled
insulin systems are in development. Inhaled insulin is effective at lowering plasma glucose, and many
patients express a preference to use it over injecting insulin. Concerns over cost-benefit and pulmonary
adverse effects do not allow recommendation of widespread use of this treatment. Nevertheless, it could
be helpful for overcoming barriers to insulin therapy in some patients with diabetes who need insulin.
The untimely withdrawal of Exubera for non-clinical reasons, therefore, is a substantial therapeutic
loss for some patients patients who are unable to inject insulin.