Improved postprandial glycemic control with insulin aspart. A randomized double-blind cross-over trial in type 1 diabetes.

Lindholm, Anders; McEwen, John; Riis, A.

doi:10.2337/diacare.22.5.801

Cited by 170 publications

(119 citation statements)

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“…The reduced tendency for self-association of insulin aspart leads to faster absorption and higher peak insulin levels in both type 1 and type 2 diabetic patients (16,27). All trials comparing short-acting analogs to unmodified human insulin showed reduced postprandial excursions in clinical use (15,16,18 -20).…”

Section: Body Weightmentioning

confidence: 99%

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A Direct Efficacy and Safety Comparison of Insulin Aspart, Human Soluble Insulin, and Human Premix Insulin (70/30) in Patients With Type 2 Diabetes

et al. 2004

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OBJECTIVE -Because there are limited data on the comparison of insulin aspart and mixed insulin in type 2 diabetes, this trial was performed to compare the efficacy and safety of preprandial insulin aspart with human soluble insulin (HI) and human premix (70% NPH/30% regular) insulin (MIX). RESEARCH DESIGN AND METHODS-A total of 231 type 2 diabetic patients were randomized to insulin aspart (n ϭ 75), HI (n ϭ 80), or MIX (n ϭ 76) for 3 months. Insulin aspart and HI were administered with or without bedtime NPH insulin. A total of 204 patients completed the trial according to protocol. HbA 1c , 7-point blood glucose, insulin dosage, and hypoglycemic episodes were recorded. The primary end point was "change of HbA 1c " from baseline to last visit. Analysis for equivalence was performed by t tests with three subtests. T he major therapeutic goals in subjects with type 2 diabetes are to optimize blood glucose control, to reduce overweight, and to normalize lipid disturbances and elevated blood pressure. It has been shown that the intensive management of type 2 diabetes reduces the risk for chronic complications (1). Diet and exercise, aiming at weight reduction, are the cornerstones of therapy. However, pharmacological treatment with oral hypoglycemic agents (OHAs) or insulin is often required (2-13). RESULTSInsulin aspart is a rapid-acting human insulin analog: replacement of proline at position B28 by aspartic acid reduces the tendency for self-association to hexamers and dimers and leads to faster absorption into the blood stream (14). Because of its short-acting profile, insulin aspart is administered immediately before main meals (15,16). Postprandial administration was also demonstrated to be a feasible therapeutic option (17). Several clinical studies showed that insulin aspart is as effective as human soluble insulin (HI) in type 1 diabetic patients (18 -23).There are only limited data for insulin aspart in type 2 diabetes and no comparisons so far among preprandial use of HI, a short-acting insulin analog, and standard human premix insulin (MIX) in a type 2 diabetic population. The aim of the present trial was to compare the efficacy and safety of three different therapeutic regimens in type 2 diabetic patients: 1) preprandial insulin aspart with or without additional NPH insulin once daily at bedtime; 2) preprandial HI with or without additional NPH insulin once daily at bedtime; and 3) MIX (70% NPH/30% regular) once or twice daily.The intensive management of blood glucose reduces the incidence of progression of diabetes complications in type 2 diabetic patients (1,24) but may require multiple-injection regimens for insulin, which is not desirable for all people with type 2 diabetes. Therefore, we wanted to find out whether MIX (70% NPH/30% regular) was as effective as insulin aspart and HI in controlling HbA 1c .RESEARCH DESIGN AND METHODS -The study was approved by 18 ethics committees responsible for the 30 centers participating in the trial, and the study was performed in accordance with the principles ...

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Section: Body Weightmentioning

confidence: 99%

“…Because of its short-acting profile, insulin aspart is administered immediately before main meals (15,16). Postprandial administration was also demonstrated to be a feasible therapeutic option (17).…”

mentioning

confidence: 99%

A Direct Efficacy and Safety Comparison of Insulin Aspart, Human Soluble Insulin, and Human Premix Insulin (70/30) in Patients With Type 2 Diabetes

et al. 2004

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“…They suggest that both aspart [106,107] and lispro [51] insulin analogues could need optimised combination with basal insulin (i. e. more than just the usual once or twice daily NPH) to improve long-term glycaemic control in both Type I [51, 105,106] and Type II [93,110,111] diabetic patients. Aspart, like lispro, can be safely mixed with NPH insulin for immediate s. c. injection [112].…”

Section: Insulin Aspartmentioning

confidence: 99%

“…In a double-blind, double-dummy, cross-over trial in patients with Type I diabetes, the post prandial glucose control after a test meal was compared between insulin aspart and regular human insulin over 6 h [105]. The analogue was given at mealtime and the regular insulin 30 min before and at mealtime.…”

Section: Insulin Aspartmentioning

confidence: 99%

Insulin analogues and their potential in the management of diabetes mellitus

Bolli

Marchi

Park³

et al. 1999

Diabetologia

323

211

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“…38 A consequence of the time-action profile for rapid-acting analogues is that higher doses of basal insulin are needed than those required with HI. 39 Thus, a smooth and predictable pharmacokinetic profile is essential. Variations in duration of action or maximum insulin levels will leave patients vulnerable to hypoglycaemia, especially at night.…”

Section: Why Do People With Diabetes Gain Weight On Insulin?mentioning

confidence: 99%

At last, a weight neutral insulin?

Fritsche

Häring

2004

Int J Obes

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In the treatment of diabetes, the positive correlation between weight gain and glycaemic control is well known. Inappropriate weight gain has been demonstrated in landmark diabetes studies, with insulin or oral antidiabetic drugs. Weight increase is associated with accelerated deterioration in beta-cell function in type II diabetes, and increases in hypertension and lipid levels in both type I and type II diabetes. Concerns about increasing weight may be a barrier to initiation or to intensification of insulin therapy. Insulin introduction may be delayed in type II diabetes, and patients may under-dose their insulin to avoid gaining weight. Insulin detemir is a new long-acting soluble insulin analogue where protraction is achieved by reversible binding to albumin. As a result, it has consistent absorption and low variability from injection to injection. Studies of insulin detemir in basal-bolus regimens in type I and type II diabetes have shown significantly less weight gain compared with NPH. There is speculation about potential mechanisms for these outcomes and results from ongoing investigations are awaited. The insulin detemir data suggest that weight gain with insulin therapy is not inevitable. The potential therefore exists for improving glycaemic control while maintaining weight stability, resulting in immediate and long-term benefits for patients.

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Improved postprandial glycemic control with insulin aspart. A randomized double-blind cross-over trial in type 1 diabetes.

Abstract: This study demonstrates the ability of insulin aspart to improve postprandial glucose control when compared with human insulin.

Cited by 170 publications

References 0 publications

A Direct Efficacy and Safety Comparison of Insulin Aspart, Human Soluble Insulin, and Human Premix Insulin (70/30) in Patients With Type 2 Diabetes

A Direct Efficacy and Safety Comparison of Insulin Aspart, Human Soluble Insulin, and Human Premix Insulin (70/30) in Patients With Type 2 Diabetes

Insulin analogues and their potential in the management of diabetes mellitus

At last, a weight neutral insulin?

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