medwireNews: Switching to fast-acting insulin aspart significantly improves glycemic control and time in glucose target range (TIR) in people with type 1 diabetes using continuous glucose monitoring (CGM), data from the real-world GoBolus study show.
Switching to faster aspart also significantly reduces time in hyperglycemia without affecting time in hypoglycemia, report Thomas Danne (Hannover Medical School, Germany) and co-authors in Diabetes Technology & Therapeutics.
The GoBolus study included 243 people (mean age 49.9 years, 55.6% men) with type 1 diabetes (mean duration 18.8 years) who were initiating faster aspart as part of their usual clinical practice. Reasons for switching to faster aspart included an aim to improve the person’s blood glucose profile, insufficient glycated hemoglobin (HbA1c) adjustment on the patient’s current regimen, and improved time flexibility in bolus administration.
Among the 155 participants who completed the 24-week study, mean HbA1c fell by a significant 0.2% (−2.1 mmol/mol), from 8.1% (64.8 mmol/mol) at baseline to 7.9% (62.8 mmol/mol) at week 24, with no mean change in insulin dose or basal/bolus insulin ratio.
There were also significant improvements in mean postprandial glucose (PPG) and mean fasting preprandial glucose, each reduced by 0.8 mmol/L (15.1 and 13.8 mg/dL, respectively), as well as mean interstitial glucose (–0.3 mmol/L, –5.4 mg/dL) and mean amplitude of glycemic excursions (–7.5 units).
There were 92 participants with sufficient data for the researchers to evaluate TIR, defined as 3.9–10.0 mmol/L (70–180 mg/dL).
They found that this measure increased significantly from a mean of 46.9% at baseline to 50.1% at week 24, corresponding to an increase of 46.1 minutes/day.
In addition, mean time spent in hyperglycemia above 10.0 mmol/L (>180 mg/dL) decreased significantly from 49.1% to 46.1%, while mean time spent above 13.9 mmol/L (>250 mg/dL) fell from 20.4% to 17.9%, corresponding to a significant 43.5 and 35.6 fewer minutes spent in these ranges per day, respectively.
By contrast, there were no significant differences between baseline and week 24 in the mean overall number of hypoglycemic episodes or the time spent in hypoglycemia.
Danne and team also note that the Diabetes Treatment Satisfaction Questionnaire score improved by 1.7 points during the course of the study and the Treatment Related Impact Measure for Diabetes improved by 5.8 points, each indicating improved quality of life.
The researchers conclude that the GoBolus study confirms “findings from the regulatory ‘onset’ trials of improved PPG control with faster aspart leading to statistically significant improvements in HbA1c and demonstrated improvements in TIR at 24 weeks without increasing time spent in hypoglycemia.”
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