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Communications to the Editor |

Pulmonary Administration of Insulin as an Aerosol Response FREE TO VIEW

Ken-ichiro Inoue Keiji Yoshioka, MD, MD, PhD
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Affiliations: Kyoto Prefectural University of Medicine, Kyoto, Japan,  Johns Hopkins University Baltimore, MD Correspondence to: Beth L. Laube, PhD, Johns Hopkins Pediatric Pulmonary, Park 316, 600 North Wolfe St, Baltimore, MD 21287-2533; e-mail: blaube@welchlink.welch.jhu.edu

Correspondence to: Ken-ichiro Inoue, MD, First Department of Internal Medicine, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan; e-mail: keni@kk.iij4u.or.jp



Chest. 1999;116(2):581-582. doi:10.1378/chest.116.2.581-a
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To the Editor:

The work of Laube and colleagues (December 1998),1 which demonstrates the efficacy of the lung as an alternative route of delivery for insulin in controlling glucose levels in patients with type 2 diabetes mellitus, is an important contribution to clinicians dealing with this illness. I would, however, like to comment on the patient population that was studied. The patients included four obese subjects, and their average body mass index (BMI) was 30.74 ± 2.23 kg/m2, which is significantly higher than the ideal BMI (22.4 kg/m2). It is now recognized that insulin resistance associated with diabetes in obese subjects is mainly caused by obesity itself. Tumor necrosis factor-α derived from adipose tissue provides a link between obesity and insulin resistance through its ability to block the insulin-stimulated tyrosine phosphorylation cascade, a mechanism that is very different from hyperglycemia-induced insulin receptor inhibition.2 It is also recognized that obese patients with diabetes should be treated with dietary therapy, exercise, and troglitazone to improve their impaired glucose tolerance.3 I do hope inhaled insulin therapy will become an alternative way to archive better glycemic control in diabetic patients. However, further comparative study about features of reaction to inhaled insulin between obese patients and nonobese subjects might prove to be interesting.

References

Laube, BL, Benedict, GW, Dobs, AS (1998) The lung as an alternative route of delivery for insulin in controlling postprandial glucose levels in patients with diabetes.Chest114,1734-1739. [CrossRef]
 
Kroder, G, Bossenmaier, B, Kellerer, M, et al Tumor necrosis factor-α and hyperglycemia-induced insulin resistance: evidence for different mechanisms and different effects on insulin signaling.J Clin Invest1996;97,1471-1477. [CrossRef]
 
Antonucci, T, Whitcomb, R, McLain, R, et al Impaired glucose tolerance is normalized by treatment with the thiazolidinedione troglitazone.Diabetes Care1997;20,188-193. [CrossRef]
 
To the Editor:

Our study attempted to evaluate the efficacy of the lung as an alternative route for the delivery of insulin in controlling diabetes mellitus. For the study, we selected a small group of individuals having a type 2 diabetes mellitus diagnosis. These included men and women, individuals who approached ideal body weight, and those who were clearly overweight. The goal was to demonstrate that the lung is an effective route for the delivery of insulin for a broad spectrum of individuals with type 2 diabetes. At no time did we attempt to define the best route of therapy or the best mode of treatment for individual patients.


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References

Laube, BL, Benedict, GW, Dobs, AS (1998) The lung as an alternative route of delivery for insulin in controlling postprandial glucose levels in patients with diabetes.Chest114,1734-1739. [CrossRef]
 
Kroder, G, Bossenmaier, B, Kellerer, M, et al Tumor necrosis factor-α and hyperglycemia-induced insulin resistance: evidence for different mechanisms and different effects on insulin signaling.J Clin Invest1996;97,1471-1477. [CrossRef]
 
Antonucci, T, Whitcomb, R, McLain, R, et al Impaired glucose tolerance is normalized by treatment with the thiazolidinedione troglitazone.Diabetes Care1997;20,188-193. [CrossRef]
 
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