Fast-acting insulin, insulin aspart provide similar glycemic control after exercise
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Fast-acting insulin aspart provides similar time in range as insulin aspart for adults with type 1 diabetes engaging in moderate- or high-intensity exercise, according to study findings published in Diabetes Technology & Therapeutics.
“While fast-acting insulin aspart has a faster onset and offset in action than standard insulin aspart when delivered subcutaneously, these differences, particularly those relating to the offset in insulin action, are not of a sufficient magnitude to impact glucose control during exercise,” David Norman O’Neal, MD, senior endocrinologist at St. Vincent’s Hospital Melbourne and professor in the department of medicine at the University of Melbourne, Australia, told Healio.
Researchers conducted an unmasked randomized crossover trial comparing fast-acting insulin aspart and insulin aspart. The study was conducted at St. Vincent’s Hospital Melbourne from June 2019 to November 2020. Participants were adults aged 18 years and older with type 1 diabetes for at least 1 year who had used an insulin pump for more than 3 months, experience with continuous glucose monitoring, and an HbA1c less than 10%. Participants were randomly assigned fast-acting insulin aspart and insulin aspart for 6 weeks each. Insulin was administered through a hybrid closed-loop delivery system (Medtronic). During each 6-week period, participants performed 40 minutes of moderate-intensity exercise and high-intensity exercise in random order, with at least 72 hours between sessions. Time in range in the 24 hours after exercise was the primary outcome.
There were 16 participants who completed the study (56.3% men; mean age, 48 years). Participants had a median time in range of greater than 80% for both insulin types with both moderate- and high-intensity exercise. There was no significant difference in time in range between fast-acting insulin aspart and insulin aspart.
There were no differences between the formulations for any glycemic or insulin delivery outcomes 2 hours after exercise, 8 hours after exercise or overnight after exercise. For the overall study period when participants used the hybrid closed-loop system, there was a slightly higher time in range with fast-acting insulin aspart compared with insulin aspart (82.3% vs. 79.3%; P = .018).
“The main pharmacokinetic characteristic impacting time in range, and particularly the risk for hypoglycemia, with exercise is the offset in insulin action,” O’Neal said. “While there are differences in insulin action profile when comparing faster aspart and standard aspart, in both cases the offset in action is characterized by a significant tail.
“People with type 1 diabetes wishing to exercise still need to plan to maintain glucose levels within a safe range even when using faster insulin aspart in conjunction with a second generation closed-loop system,” O’Neal added. “However, with appropriate forward planning, they can exercise safely and with confidence.”
For more information:
David Norman O’Neal, MD, can be reached at dno@unimelb.edu.au.
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