medwireNews: Switching to fast-acting insulin aspart (faster aspart) is associated with an increased time in range (TIR) and reduced glycemic variability, show data from a real-world observational study.
The 12-month retrospective study involved 438 people (average age 44.6 years, 60% men) with type 1 diabetes who were seen at two Belgian clinics. The decision to switch to mealtime faster aspart was prompted by the person’s usual physician and was “part of the process of continuous improvement of management of [type 1 diabetes],” say the researchers.
Around half of the patients were using glargine U100 as their basal insulin, with the others using long-acting formulations. They were all using continuous glucose monitoring, and their average baseline TIR was 50.3%.
By 6 months after switching this had improved to an average of 54.3% and by 12 months it was 55.5%, which the team notes corresponds to an additional 75 minutes per day spent inside the ideal blood glucose range of 70–180 mg/dL (3.9–10.0 mmoL/L).
Time below range slightly increased during the first 6 months, from an average of 7.4% to 7.6%, and then fell to 6.8% at 12 months. The time spent below 54 mg/dL (3.0 mmol/L) did not change from baseline to 6 months (3.1 to 3.1%) but then significantly improved to 2.5% by 12 months.
In addition, time above range improved significantly, by an average of 4.6 percentage points, and time above 250 mg/dL (13.9 mmoL/L) improved by a significant 3.4 percentage points across the 12 months of follow-up.
Glycemic variability also significantly improved between baseline and 12 months, whether measured as the coefficient of variability (average 41.9 to 40.4%) or the standard deviation (average 72.7 to 65.8%).
Christophe De Block (University of Antwerp, Belgium) and study co-authors observe that upwards of 30% of people with type 1 diabetes are excluded from clinical trials such as the ONSET series for faster aspart.
This often includes people with hypoglycemia unawareness and those with high glycated hemoglobin (HbA1c) levels, they say. The researchers note that even the GoBolus study of real-world faster aspart use included only people with HbA1c levels of 7.5–9.5% (58–80 mmol/mol).
And they add that “impaired awareness occurs in approximately 25% of adult patients with [type 1 diabetes] and renders patients to a 3- to 6-fold increased risk of severe hypoglycaemia.”
HbA1c remained largely stable during the study, although the team found “a positive evolution in HbA1c categories,” with a reduction in the proportion of people with HbA1c greater than 8.0% (64 mmol/mol) and corresponding increases in the lower categories.
Just 10 people stopped using faster aspart, most because they were unable to inject 0.5 U (due to injector pen design), or because they felt glycemic control had been better with a previous insulin.
“We also explored the risk of catheter occlusions, which might occur when switching to a new insulin preparation formulation,” write De Block and team in Diabetes, Obesity and Metabolism.
They identified this issue in four people, but say: “After adjusting the speed of administration of a bolus to ‘normal’ speed, no more catheter occlusions occurred.”
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