Postprandial time in tight range with faster insulin aspart compared with standard insulin aspart in youth with type 1 diabetes using automated insulin delivery

Abstract

Aims

The aim of this study was to assess postprandial glycaemic outcomes using automated insulin delivery with faster acting insulin aspart (FIA) or standard insulin aspart (SIA) over 4 weeks in youth (aged 10–18 years) with type 1 diabetes.

Materials and Methods

We undertook a secondary analysis of postprandial glycaemic outcomes from a double-blind, randomised, crossover study comparing FIA to SIA using an investigational version of MiniMed™ 780G. Endpoints included postprandial time in tight range (70–140 mg/dL; TITR), postprandial glucose excursions and peak glucose, and incremental area under curve (iAUC).

Results

The mean ± SD age of 30 included participants was 15.0 ± 1.7 years, 47% were male, mean HbA1c was 7.5% ± 0.9% (58 ± 9.8 mmol/mol) and the number of meals per day per participant was 3.2 ± 1.2 meals. Overall, the postprandial outcomes were improved with FIA compared with SIA. Mean glucose at the start of the meal was 151 mg/dL in the FIA group and reached a peak glucose of 194 mg/dL, compared with starting level of 151 mg/dL in the SIA group and a peak of 198 mg/dL (difference in excursion: −3.8 mg/dL; 95% confidence interval −5.8 to −1.7; p <0.001). FIA group also had a 1.9% increase in mean TITR (p = 0.02) and a 2.0-mg/dL decrease in mean iAUC (p = 0.003). Differences in outcomes were the most noticeable for breakfast, meals with a larger amount of carbohydrates (>45 g) and participants with lower insulin-to-carbohydrate ratios.

Conclusions

Faster insulin formulation with AID improved postprandial glycaemic outcomes and could be a useful therapeutical option in youth with type 1 diabetes that have challenges achieving glycaemic targets.