Inhaled insulin can be given to diabetics, but only those who struggle with injected insulin, according to NICE.
The final appraisal document states that patients shown to have a severe phobia of insulin or those who have serious and persistent problems with injection sites, caused by lipohypertrophy, for example, would be eligible. Inhaled insulin can also be given if dietary changes, oral hypoglycaemic agents and insulin injections fail to control blood sugar.
Clinical trial findings indicate that inhaled insulin has similar effectiveness to short-acting subcutaneous insulin, said NICE.
But the high cost of inhaled insulin means it should not be routinely offered to diabetics.
Inhaled insulin should only be continued beyond six months if HbA1c improvements are deemed to be clinically beneficial.
But most GPs will not be responsible for initiating inhaled insulin therapy as it should begin and monitored at a specialist diabetes centre.
Andrea Sutcliffe, deputy chief executive of NICE, said: ‘We have also recommended further research takes place so we can better establish the place of this innovative approach to delivering insulin.’
Simon O’Neill, Director of Care at Diabetes UK said: 'Diabetes UK welcome the revised final guidance. It is a significant step forward from the initial recommendations following the consultation process.
‘We are pleased that needle phobias can now be diagnosed by a member of a diabetes care team rather than just mental health professionals.
‘However, we still believe the potential benefits in reducing the risk of complications for those who delay moving on to insulin to avoid injections have not been adequately recognised. NICE have recognised that some people would prefer to use inhaled insulin. They have also recognised the improvement it can bring to quality of life and patient satisfaction. However, their decision has not taken all these factors into account for the wider diabetes population, and it still comes down to cost.
‘We do not want a repeat of the situation with insulin pumps. Whilst other countries have enjoyed the benefits, we have fallen behind and access has been restricted.
‘The decision to prescribe Exubera should lie with the individual patient and his or her diabetes specialist.’