Use of Inhaled Insulin with Automated Insulin Delivery Systems

Innovations in diabetes medications and technologies have revolutionized our approach to the management of diabetes. Automated insulin delivery (AID) systems have substantially improved overall glycemia and time-in-range; however, AID systems do not eliminate postprandial hyperglycemia or correct hyperglycemia quickly, given the glucose-lowering action lag of insulins that are used in AID systems. Inhaled insulin offers a novel approach to prandial insulin delivery, characterized by rapid absorption kinetics and a "rapid on, rapid off" pharmacokinetic profile that closely mimics endogenous insulin secretion and can compensate for the glucose-lowering action delay of subcutaneous insulin delivery. While the integration of inhaled insulin with AID systems presents an opportunity to address the limitations of subcutaneous insulin formulations, challenges remain in harmonizing the pharmacokinetics of inhaled insulin with AID systems. This article reviews the current evidence supporting the potential role of concomitant use of TI with AID and gaps in our current knowledge that need to be filled with future studies.