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Use of fast-acting insulin aspart in insulin pump therapy in clinical practice

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  • Mark Evans
  • Antonio Ceriello
  • Thomas Danne
  • Christophe De Block
  • J Hans DeVries
  • Marcus Lind
  • Chantal Mathieu
  • Kirsten Nørgaard
  • Eric Renard
  • Emma G Wilmot
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Fast-acting insulin aspart (faster aspart) is a novel formulation of insulin aspart (IAsp) containing the additional excipients niacinamide and L-arginine. The improved pharmacological profile and greater early glucose-lowering action of faster aspart compared with IAsp suggests that faster aspart may be advantageous for people with diabetes using continuous subcutaneous insulin infusion (CSII). The recent onset 5 trial was the first to evaluate the efficacy and safety of an ultra-fast-acting insulin in CSII therapy in a large number of participants with type 1 diabetes (T1D). Non-inferiority of faster aspart to IAsp in terms of change from baseline in HbA1c was confirmed with an estimated treatment difference (ETD) of 0.09% (95% CI 0.01; 0.17; P < 0.001 for non-inferiority [0.4% margin]). Faster aspart was superior to IAsp in change from baseline in 1-h postprandial glucose (PPG) increment after a meal test (ETD [95% CI] -0.91 mmol/L [-1.43; -0.39]; P = 0.001) with statistically significant improvements also at 30 min and 2 h. The overall rate of severe or blood glucose-confirmed hypoglycaemia was not statistically significantly different between treatments, with an estimated rate ratio of 1.00 (95% CI 0.85; 1.16). A numerical imbalance in severe hypoglycaemic episodes between faster aspart and IAsp was seen in the treatment (21 vs 7) and 4-week run-in periods (4 vs 0). Experience from clinical practice indicates that all pump settings should be reviewed when starting faster aspart in CSII, and that the use of continuous glucose monitoring or flash glucose monitoring, along with a good understanding of meal content and bolus type, may also facilitate optimal use. This review summarizes the available clinical evidence for faster aspart administered via CSII and highlights practical considerations based on clinical experience that may help healthcare providers and people with T1D successfully initiate and adjust faster aspart in CSII. This article is protected by copyright. All rights reserved.

Original languageEnglish
JournalDiabetes, Obesity and Metabolism
Issue number9
Pages (from-to)2039-2047
Number of pages9
Publication statusPublished - Sep 2019

Bibliographical note

© 2019 The Authors. Diabetes, Obesity and Metabolism published by John Wiley & Sons Ltd.

    Research areas

  • CSII, insulin pump therapy

ID: 57277196