Glucose control using fast‐acting insulin aspart in a real‐world setting: A 1‐year, two‐centre study in people with type 1 diabetes using continuous glucose monitoring

Abstract

Aim To evaluate the efficacy and safety of switching from traditional mealtime insulins to fast‐acting insulin aspart (Fiasp) in a “real‐world” clinical practice setting in adult people with type 1 diabetes (PWD1) who were using intermittently scanned or real‐time continuous glucose monitoring (isCGM or rtCGM, respectively). Materials and Methods Data from 438 adult PWD1 (60% men, age 44.6 ± 16.2 years, diabetes duration 21.5 ± 14.0 years, isCGM/rtCGM: 391/47, multiple daily injections/continuous subcutaneous insulin infusion: 409/29), who initiated Fiasp from January 2018 to May 2020, were analysed. The primary objective was the evolution of time in range (TIR; 70‐180 mg/dL) at 6 and 12 months. Secondary objectives included change in HbA1c, body mass index (BMI), insulin doses, time below range (<70 and <54 mg/dL), and time above range (>180 and >250 mg/dL). Results TIR improved from 50.3% ± 15.6% to 54.3% ± 15.1% at 6 months (n = 425) and to 55.5% ± 15.2% at 12 months (n = 385) (P < .001), corresponding to 57 min/d at 6 months and 75 min/d at 12 months. Time spent below 54 mg/dL evolved from 3.1% ± 3.3% to 3.1% ± 3.7% and 2.5% ± 3.0% at 6 and 12 months, respectively (P = .011). Also, time spent above 180 mg/dL decreased from 42.3% ± 16.7% at start by 4.2% at 6 months and by 4.6% at 12 months (P < .001). The proportion of people reaching TIR more than 70% increased from 11.0% to 14.8% (P = .002), and those spending less than 4% at time less than 70 mg/dL increased from 36.1% to 42.1% (P = .002). After 12 months, HbA1c, insulin doses, and BMI did not change significantly. Conclusions In a Belgian real‐world setting of adult PWD1, switching to Fiasp was associated with a 5% increased TIR after 12 months, corresponding to 75 min/d, in combination with less time spent below and above range.

Effect of ultra-rapid insulin aspart on glycemic control in children with type 1 diabetes: the experience of a Portuguese tertiary centre

“…Similarly, we had a 12% decrease in TAR, also superior to what was found on both studies (3% [ 19 ] and 4.6% [ 20 ]). Nevertheless, A1c did not improve significantly, which is aligned with some [ 17 , 20 ], but not all studies [ 16 , 18 , 19 ]. Besides the fact that the study was carried out in a population with a reasonably good metabolic control (Table 1 ), comparing the average of A1c with the previous year of faster aspart’s introduction may have been a limitation.…”

“…Comparing with adults’ trials, the 11% increase in TIR observed in our study was considerably higher, 3.2% [ 19 ] and 4% [ 20 ]. Similarly, we had a 12% decrease in TAR, also superior to what was found on both studies (3% [ 19 ] and 4.6% [ 20 ]). Nevertheless, A1c did not improve significantly, which is aligned with some [ 17 , 20 ], but not all studies [ 16 , 18 , 19 ].…”

“…The results of ONSET trials [ 16 – 18 ] have been supported by several “real-world” studies in adults [ 19 , 20 ]; however, studies in pediatric population are still lacking. Comparing with adults’ trials, the 11% increase in TIR observed in our study was considerably higher, 3.2% [ 19 ] and 4% [ 20 ]. Similarly, we had a 12% decrease in TAR, also superior to what was found on both studies (3% [ 19 ] and 4.6% [ 20 ]).…”

Rapid‐acting insulin analogues: Theory and best clinical practice in type 1 and type 2 diabetes

“…However, CGM also showed similar beneficial effects in real-life conditions. 68,69 Although Fiasp was not associated with an overall increased risk of hypoglycaemia compared with Iasp, in ONSET 1, higher rates of early postmeal hypoglycaemia were noted, 59 illustrating the need for careful management of subjects prone to early postprandial hypoglycaemia, such as those with gastroparesis.…”

Glycaemic Control in People with Diabetes Starting Treatment with Fast-Acting Insulin Aspart: a US Database Study

“…There are limited real-world studies with faster aspart [17,18,22]. One of these studies explored patient and physician perspectives regarding the use of faster aspart and highlighted the benefit of increased dosing flexibility with faster aspart compared with other…”