Patients with Type 1 Diabetes Mellitus require insulin therapy due to the destruction of beta cells.1 The optimal management involves administering insulin in a physiological manner, combining basal insulin (such as NPH or ultralente) and bolus insulin typically administered using rapid-acting insulin, which is evaluated by its effect on postprandial glucose level.2,3 Despite the significant impact of these injections in reducing HbA1c levels and subsequently decreasing microvascular and macrovascular complications,4 poor medication adherence remains a challenge due to the discomfort and inconvenience associated with multiple daily injections.5

To address this issue, ultra-rapid inhaled insulins, such as Technosphere Insulin (TI;AFREZZA), have been developed. TI is a formulation of recombinant monomeric human insulin adsorbed onto Technosphere microparticles to the lung and has a faster onset of action (approximately 12 min after injection) and a similar duration of action (around 2 h) compared to rapid-acting insulins like Lispro, Aspart, or Glulisine.6,7

However, within the basal-bolus regimen, the impact of Technosphere Insulin on HbA1c, hypoglycemia, postprandial glucose, and patient weight remains controversial.

This meta-analysis aims to elucidate these effects and provide a comprehensive evaluation of Technosphere Insulin in the treatment of Type 1 Diabetes Mellitus. It is hypothesized that there is no inferiority between using Technosphere Insulin (Afrezza) and rapid-acting insulins within the basal-bolus regimen regarding weight maintenance, HbA1c levels, and incidence of hypoglycemia.