Fast-acting insulin aspart - from insulin portraits to patient portraits

Abstract

Postprandial hyperglycemia is an independent risk factor for cardiovascular disease (CVD). Bolus insulins aim to mimic the physiological action of endogenous insulin secreted in response to food intake to control peaks of postprandial glycemia (PPG). Ultrafast insulin aspart is insulin with a high rate of absorption into the bloodstream that is designed to mimic the physiological prandial release of insulin more accurately than currently available short-acting or ultra-short-acting insulin preparations. The high bioavailability of ultrafast insulin aspart was achieved through the addition of two excipients — nicotinamide and L-arginine. At the same time, L-arginine ensures the stability of the drug, and nicotinamide is responsible for the accelerated absorption of insulin after subcutaneous administration. The results of clinical studies showed that subcutaneous injection of ultra-fast-acting insulin aspart provided an earlier onset of action and a greater effect of lowering blood glucose levels compared with ultra-short-acting aspart. The use of ultrafast insulin aspart both with subcutaneous injections and with CSII provided better control of PPG compared to the analogue of ultra-short-acting aspart. Moreover, the use of ultra-fast-acting insulin aspart 20 minutes after the start of a meal was not inferior to the ultra-short-acting aspart administered before meals in terms of HbA1c control. This emphasizes the possibility of using ultra-fast insulin aspart both before and after meals, without impairing glycemic control.