Over the last century, diabetes care has experienced a wave of transformations, from diets and herbal remedies to advanced glucose monitoring, Artificial Intelligence (AI)-driven precision care, and even new categories of medications to deal with associated risk factors. Yet one aspect has remained surprisingly static: How insulin is delivered.
Despite being a cornerstone therapy for individuals with Type 1 and many with Type 2 diabetes, insulin is still administered as subcutaneous injections. However, as we push for better outcomes it’s clear that effectiveness depends not just on what is prescribed, but how it’s delivered as well as the patients adherence to the treatment.
Achieving and maintaining adequate glycaemic (blood sugar levels) control is at the heart of diabetes care and it relies just as much on patient behaviour as it does on treatment.
Many patients, especially those with type 1 and some with type 2 diabetes, need Multiple Daily Injections (MDI) regimen – which, simply put, involves long-acting insulin shots each day (basal), along with additional doses before meals (bolus). While effective, this can feel overwhelming and difficult to adhere to. The frequency of injections, planning around meals, the discomfort of injecting in public, and fear of visible stigma all contribute to emotional fatigue and reduced adherence to treatment.
Over time, this burden can lead to missed doses, delayed initiation, or even complete discontinuation of insulin therapy. This isn’t because patients question the efficacy of insulin, but because the experience of taking it feels invasive, burdensome, or emotionally difficult. In such cases, the mode of delivery becomes more than just a method—it becomes a barrier.
In a chronic condition like diabetes, where outcomes are tied closely to consistent self-management, even seemingly small barriers can compound into real clinical consequences. This is why the delivery method must be viewed not just as a functional necessity, but as a key determinant of treatment continuity and patient experience.
Delivering insulin without an injection has been researched for decades. Several strategies over the years have been unsuccessful. The respiratory tract – for example – has been used as a route for delivering drugs not just for lung diseases but also for conditions like migraine, epilepsy and more recently insulin. The absorptive surface of the lung is large (as big as a tennis court). Insulin administered through inhalation rapidly enters the blood stream and reduces blood sugar. Taken just before a meal using a simple easy to use dry powder inhaler, it prevents the post meal glucose spike and the effect closely resembles what happens in physiological conditions. The effect lasts for up to three hours and reduces the risk of low sugar later. This has been clinically tested in multiple clinical trials including over 200 patients from India.
It can help foster timely initiation, improve day-to-day compliance, and in the long term, drive better glycaemic outcomes. But for this to happen at scale, the medical community must begin viewing delivery innovation not merely as convenience, but as a clinical enabler — one that meets people where they are, tackling the inertia that often prevents people with diabetes from starting or sticking to insulin therapy. If we are to move the needle on diabetes care in India, we must first reimagine how we deliver the medicine that matters most.
This article is authored by Dr Jaideep Gogtay, Global Chief Medical Officer, Cipla Ltd.