Abstract
AimsPost-prandial hyperglycemia remains an unmet need in the management of type 1 diabetes (T1D). In randomized trials, faster insulin aspart (FIA) showed modest but significant reductions of glycemic spikes after meals. Whether such benefit is evident in routine clinical practice is unclear.MethodsWe analyzed data of patients with T1D at the time they switched from a prior bolus insulin to FIA and at the first available follow-up. The primary endpoint was the change in the time spent in hyperglycemia > 250 mg/dl during daytime from flash glucose monitoring (FGM). Secondary outcomes included the change in HbA1c, body weight, insulin dose and other FGM metrics.ResultsWe included 117 patients with T1D on multiple daily injections who switched to FIA, 57 of whom had data from FGM. Patients were 41-year-old, 51.3% men, with 19.3 years diabetes duration and a baseline HbA1c of 7.7% (60 mmol/mol). Mean observation time was 4.3 months. After switching to FIA, HbA1c declined by 0.1% (1 mmol/mol) only in patients with baseline HbA1c > 7.0% (53 mmol/mol). Time spent in hyperglycemia > 250 mg/dl during daytime was significantly reduced from 14.8 to 11.9% (p = 0.006). Time in range improved from 48.3 to 51.0% (p = 0.028). Results were consistent across various patient characteristics.ConclusionsUnder routine care, patients with T1D who switched to FIA experienced a reduction in the time spent in hyperglycemia > 250 mg/dl during daytime and an increase in time in range. These improvements may be due to better control of post-prandial hyperglycemia, as observed in trials.
Highlights
In people with type 1 diabetes (T1D), post-prandial glucose excursions contribute to increasing glucose variability and decreasing time in range (TIR)
As for the ongoing therapy at the time of switch, a similar number of patients were on insulin aspart (42.7%) and lispro (42.6%,), while much less were on glulisine (15.4%)
We show that patients with T1D on multiple daily insulin injections and suboptimal glycemic control who switched from other bolus insulins to faster insulin aspart (FIA) experienced a significant improvement in TIR due to a reduction in time spent in hyperglycemia > 250 mg/dl during daytime, as evidenced from flash glucose monitoring (FGM) data
Summary
In people with type 1 diabetes (T1D), post-prandial glucose excursions contribute to increasing glucose variability and decreasing time in range (TIR). This is demonstrated by studies on a dedicated algorithm to control post-prandial glucose with closed loop insulin delivery [1] and by studies showing post-prandial glucose control with a sodiumglucose co-transporter inhibitor [2]. Mitigating post-prandial hyperglycemia is one of the aims of T1D glycemic management. To this end, interventions that approximate physiological post-prandial responses should actively be sought to reduce the risk of complications [7]. Despite decades of optimization of basal-bolus insulin therapy, handling of post-prandial hyperglycemia with insulin injections remains an unmet need [8]
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