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Fast-acting insulin improves mealtime glucose control in adults with type 2 diabetes taking large doses
Fast-acting insulin aspart is a potentially more effective treatment for the management of postprandial glucose in adults with insulin-resistant type 2 diabetes compared with insulin aspart, according to findings published in Diabetic Medicine.
“People with insulin-resistant type 2 diabetes receiving basal insulin and oral anti-diabetes drug therapy often require treatment intensification with bolus insulin to improve glycemic control,” Keith Bowering, MD, FRCPC, FACP, a clinical professor in the division of endocrinology and metabolism at the University of Alberta in Canada, and colleagues wrote. “However, [postprandial glucose] control frequently remains suboptimal, even in people receiving a high bolus insulin dose. Further, conventional rapid-acting insulin analogues do not seem to offer a therapeutic advantage over regular human insulin in these people; this is concerning and highlights the need for more efficacious bolus insulins in this population.”
Bowering and colleagues performed a post hoc, post-randomization analysis of a randomized, double-blind phase 3 trial comparing mealtime faster insulin aspart with mealtime insulin aspart in adults with type 2 diabetes. As part of the analysis, the researchers stratified the participants based on meal test bolus insulin dose into three groups: 10 U or less per dose (n = 171; 53.1% women; mean age, 61 years), more than 10 U to 20 U (n = 289; 50.9% women; mean age, 58 years) and more than 20 U (n = 146; 48.6% women; mean age, 58 years). In the original phase 3 trial, participants were randomly assigned to the faster insulin (n = 345) or insulin aspart (n = 344) after an 8-week run-in period. Both treatments were administered no more than 2 minutes before mealtime and an 80 g standard liquid meal test was used to measure postprandial glucose during the run-in period and after 26 weeks.
Although the researchers found no significant treatment differences between fast-acting insulin aspart and insulin aspart in the 10 U or less and more than 10 U to 20 U bolus insulin subgroups, there was a significant improvement in postprandial glucose levels in the more than 20-U group at the 1-hour (–1.31; 95% CI, –2.35 to –0.27), 2-hour (–1.23; 95% CI, –2.14 to –0.33), 3-hour (–0.86; 95% CI, –1.84 to –0.07) and 4-hour (–1.01; 95% CI, –1.87 to –0.15) marks. Despite this, the researchers noted a lack of a significant change in HbA1c at the end of 26 weeks compared with baseline.
“The [postprandial glucose] advantage of faster aspart may have been most evident in those receiving [more than] 20 units of bolus insulin because these people had a higher observed BMI than those receiving lower doses,” the researchers wrote. “The absorption of rapid-acting insulin analogues is delayed in people with obesity, and the glucose-lowering action is further delayed as the dose of the insulin is increased.” – by Phil Neuffer
Disclosures: The study was funded by Novo Nordisk. Bowering reports he has served on advisory panels for AstraZeneca, Boehringer Ingelheim, Eli Lilly, Johnson & Johnson, Merck, Novo Nordisk and Sanofi, and on the speakers bureaus for Novo Nordisk and Sanofi. Please see the study for all other authors’ relevant financial disclosures.