Ultrafast-acting insulin effective in children
medwireNews: The pharmacodynamics of faster-acting insulin aspart (faster aspart) in children are similar to those in adults, suggesting its ability to improve postprandial glycemic control in children with type 1 diabetes, say researchers.
The insulin, which was recently approved in Europe and is undergoing regulatory review in the USA, was significantly faster to appear in the blood of children and adolescents than its predecessor insulin aspart.
The 12 children, 13 adolescents, and 13 adults with type 1 diabetes who completed the study received a 0.2 U/kg dose of one of the insulins (determined by randomization) immediately before consuming a standardized liquid meal. They repeated the procedure with the alternative insulin at a second study visit.
Faster aspart was detectable in the blood between 5.2 and 5.5 minutes after administration, compared with 9.8 to 12.3 minutes for insulin aspart. Likewise, the time to 50% of maximum concentration was 23.3 to 26.3 minutes compared with 30.9 to 37.0 minutes, with all these differences being statistically significant.
Time to maximum concentration of insulin was numerically shorter for faster aspart than insulin aspart in children (48.5 vs 53.3 min) and adolescents (53.5 vs 62.9 min), and significantly shorter in adults (59.3 vs 75.0 min).
In line with these pharmacodynamics findings, all three age groups had reduced plasma glucose excursions with faster aspart versus insulin aspart, with the differences being significant in the children.
Eight participants needed glucose for hypoglycemia after faster aspart and eight needed it after insulin aspart, with just one intervention for each occurring within 2 hours after the dose.
Writing in Pediatric Diabetes, researcher Thomas Danne (Kinder- und Jugendkrankenhaus, Hannover, Germany) and team suggest that faster aspart could meet a need for postmeal insulin dosing, noting that, in younger children, “where eating behavior is known to vary considerably, postmeal insulin administration might facilitate a better match between meal carbohydrate content and insulin dose.”
Current fast-acting insulins cannot be used postmeal without compromising glucose control, they say, but research in adults suggests that faster aspart may be used up to 20 minutes after a meal.
“Postmeal dosing of faster aspart has not been tested in children or adolescents so far, but a clinical trial is currently being conducted to investigate this option,” says the team.
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