Fast-Acting Insulin Aspart for Glycemic Control in Type 1 Diabetes

Both mealtime and postmeal faster insulin aspart are noninferior to mealtime conventional insulin aspart, regarding HbA1c change from baseline.

Patients with type 1 diabetes mellitus (T1DM) who took fast-acting insulin aspart at mealtime showed improved glycated hemoglobin A1c (HbA1c) and lower increments of postprandial plasma glucose compared with patients taking conventional insulin aspart, according to recent research published in Diabetes Care.

David Russell-Jones, MBBS, PhD, from the Diabetes and Endocrinology Department at Royal Surrey County Hospital and the University of Surrey in Guildford, United Kingdom, and colleagues analyzed change in baseline HbA1c in patients with T1DM randomly assigned to receive fast-acting insulin aspart (faster aspart) at mealtime (n=381), faster aspart after mealtime (n=380), or conventional insulin aspart (IAsp; n=382) in combination with insulin detemir after an 8-week run-in.

Patients were included in the study if they were taking insulin detemir or glargine for a minimum of 4 months and receiving basal-bolus insulin for a minimum of 12 months and had a body mass index (BMI) <35 kg/m2 and HbA1c between 7.0% and 9.5% (53-80 mmol/mol).

“The current trial confirmed that, in subjects with [T1DM] on a basal-bolus regimen, both mealtime and postmeal faster aspart are noninferior to mealtime IAsp regarding HbA1c change from baseline,” the researchers wrote.

After 26 weeks, patients in the mealtime faster aspart group (estimated treatment difference [ETD], −0.15%; 95% CI, −0.23% to −0.07%) and the after mealtime faster aspart group (ETD, 0.04%; 95% CI, −0.04% to 0.12%) had lower HbA1c levels compared with the IAsp group, with a statistically significantly lower HbA1c level seen in the mealtime faster aspart group (P =.0003).

The researchers noted there were statistically significantly lower postprandial plasma glucose increments in the mealtime faster aspart group (−21.21 mg/dL (95% CI, −29.65 to −12.77 mg/dL; P <.0001) after 1 hour (ETD, −1.18 mmol/L; 95% CI, −1.65 to −0.71 mmol/L), as well as statistically significantly lower levels in the same group (−12.01 mg/dL; 95% CI, −23.33 to −0.70 mg/dL; P =.0375) 2 hours (−0.67 mmol/L; 95% CI, −1.29 to −0.04) after the meal compared with the IAsp group.

“In certain situations, postmeal dosing of insulin may offer increased flexibility compared with mealtime dosing — for instance, when an individual is unable to predict the exact timing or carbohydrate content of a meal in advance (eg, on social occasions), when experiencing lack of appetite or nausea (eg, the very elderly or frail), when appetite is unpredictable (eg, children), if an injection is forgotten, or if an individual is anxious about severe hypoglycemia,” the researchers wrote. “Subjects randomized to dosing faster aspart postmeal for all meals maintained overall glycemic control noninferior to that obtained with mealtime IAsp, indicating that flexibility in timing of dose with faster aspart does not lead to worsening of glycemic control.”

Disclosures: The researchers report financial relationships with various pharmaceutical companies, including Novo Nordisk, which funded the study.

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Russell-Jones D, Bode BW, De Block C, et al. Fast-acting insulin aspart improves glycemic control in basal-bolus treatment for type 1 diabetes: results of a 26-week multicenter, active-controlled, treat-to-target, randomized, parallel-group trial (onset 1) [published online March 29, 2017]. Diabetes Care. doi:10.2337/dc16-1771