Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog

NICE guidance on Inhaled Insulin

The National Institute of Health and Clinical Excellence (NICE) has published a Technology Appraisal on Inhaled Insulin for the treatment of diabetes (type 1 and 2).

As previously reported, NICE were not expected to widely endorse this product. Additionally, the Scottish Medicines Consortium (SMC) has rejected Inhaled Insulin for use on the NHS in Scotland.

The guidance recommends that inhaled insulin (Exubera®) is not routinely used. It suggests there may be a place where glycaemic control is poor despite maximal therapy with alternative hypoglycaemics AND initiation or titration of injectable insulin is not possible because of:

  • marked and persistent fear of needles diagnosed by a diabetes or mental health specialist
  • severe and persistent problems with injection sites despite support with injection site rotation

If these criteria are met it is recommended that initiation and monitoring of treatment is carried out in a specialist centre and that treatment is only continued if there is evidence of clinically relevant improvements in glyclosylated haemaglobin (HbA1c).

Action: Inhaled insulin is not appropriate for initiation in primary care. Responsibility for prescribing may pass from specialist centres to primary care but this should be accompanied by advice regarding criteria for monitoring, continuation and cessation of treatment.

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