Comparison of pharmacodynamics and pharmacokinetics of ultra-rapid-acting insulin aspart and rapid-acting insulin aspart around continuous moderate intensity exercise in adults with type 1 diabetes: A randomised controlled trial

AIMS: To compare the effects of dose reductions of ultra-rapid-acting insulin aspart (URA-IAsp) and rapid-acting insulin aspart (IAsp) on blood glucose concentrations during continuous moderate-intensity exercise in people with type 1 diabetes (T1D).

MATERIALS AND METHODS: In this double-blind, laboratory-controlled study, 43 adults with T1D completed four experimental visits in a randomised crossover design. Participants injected a 50% or 75% reduced dose of URA-IAsp or IAsp with a standardised breakfast 60 min prior to 45 min of cycling at ~61% V̇O2peak. The same insulin type and dose were administered 4 h after the first injection, alongside an identical lunch meal. Venous blood samples were taken at 5-, 10-, and 15-min epochs, for a total of 70 timepoints, throughout the trial day until 4 h after the second injection to determine blood glucose and insulin concentrations. The primary endpoint was the four-way comparison of blood glucose change from exercise start to end.

RESULTS: Blood glucose declined during exercise to a similar extent between 50% dose URA-IAsp (-4.0 ± 2.8 mmol L-1) and all other conditions (all p > 0.05), yet fell more in the 50% IAsp dose (-5.1 ± 3.0 mmol L-1) compared to the URA-IAsp (-2.8 ± 3.3 mmol L-1) and IAsp (-3.4 ± 3.3 mmol L-1) 75% reduced dose conditions (both p < 0.05). Differences in blood insulin concentrations between trials were only resultant of insulin doses and not insulin type from 30 min after the first insulin injection.

CONCLUSIONS: Insulin dose reductions around acute moderate-intensity exercise yield similar glucose-lowering effects with URA-IAsp and IAsp. The extent of dose reductions exerts greater influence on glycaemia than the type of fast-acting insulin.