Patient choice stops at inhaled insulin

EMBARGO: 00:01H (London time) Friday April 28, 2006. In North America the embargo lifts at 18:30H ET Thursday April 27, 2006.

An editorial In this week's Issue of THE LANCET calls for physicians and patients to decide on whether It Is appropriate to use Inhaled Insulin for diabetes, even though last week the UK's National Institute for Health and Clinical Excellence (NICE) released its appraisal document on inhaled insulin, open for consultation until May 10, which concluded that the treatment should not be offered to patients. The editorial states: 'NICE supported its conclusion with three main arguments: that the data on quality of life and patient preferences are insufficient and not generalisable; expert views that "using injected insulin is not usually a concern for the majority of people with diabetes"; and, in a rather curious conclusion, NICE claims that the effect that patients might move on to inhaled insulin earlier and therefore avoid or delay long-term diabetic complications, is "insufficient to provide support for a cost-effective use of this technology".

The editorial concludes: 'Inhaled insulin will cost an additional 500 per patient per year. Clearly, it is not suitable for everyone with diabetes. For the group that might arguably benefit most from avoiding or minimising injections--children and adolescents--there is currently insufficient evidence on efficacy and safety. Long-term safety data are still lacking in terms of lung damage and effects on the development of insulin antibodies. With these caveats in mind, however, it should be left to the individual physicians in discussion with their patients to make appropriate use of this new technology.'

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Contact: The Lancet Press Office, T) +44 (0)20 7424 4949/4249; pressoffice@lancet.com


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