The Distinct Prandial and Basal Pharmacodynamics of IDegAsp Observed in Younger Adults Are Preserved in Elderly Subjects with Type 1 Diabetes

Brunner, Martina; Pieber, Thomas R.; Korsatko, Stefan; Kojzar, Harald; Svendsen, Anne Louise

doi:10.1007/s40266-015-0272-y

Cited by 26 publications

(23 citation statements)

References 13 publications

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“…The same was seen for insulin aspart, although it was only statistically significant for total exposure. A similar trend has been observed in previous studies for the insulin degludec/insulin aspart combination, insulin degludec alone and for insulin detemir [19–21], and would be in accordance with a reduced insulin clearance with increasing age [22]. Importantly, we found comparable AUC GIR,0-t and GIR max in elderly and younger adults, as previously shown [19].…”

Section: Discussionsupporting

confidence: 92%

“…A similar trend has been observed in previous studies for the insulin degludec/insulin aspart combination, insulin degludec alone and for insulin detemir [19–21], and would be in accordance with a reduced insulin clearance with increasing age [22]. Importantly, we found comparable AUC GIR,0-t and GIR max in elderly and younger adults, as previously shown [19]. The similar glucose-lowering effect in elderly and younger adults despite higher exposure in the elderly is in line with the well-known decrease in insulin sensitivity with aging [23, 24].…”

Section: Discussionsupporting

confidence: 90%

“…Another limitation of the present study was the relatively few subjects per age group. Still, the number of subjects was higher than in similar previous studies in elderly subjects [19, 20], and was sufficient to demonstrate statistically significant differences in pharmacokinetic and pharmacodynamic properties between faster aspart and insulin aspart in both age groups.…”

Section: Discussionmentioning

confidence: 69%

“…Accordingly, to our knowledge, glucose clamp studies comparing the pharmacokinetic and pharmacodynamic properties of an insulin between elderly and younger adults and/or between two insulins in elderly subjects have only been conducted for a few insulin products [19, 20, 28]. Therefore, a strength of the current study was the use of the euglycaemic glucose clamp technique to assess the pharmacodynamic properties.…”

Section: Discussionmentioning

confidence: 99%

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A Comparison of Pharmacokinetic and Pharmacodynamic Properties Between Faster-Acting Insulin Aspart and Insulin Aspart in Elderly Subjects with Type 1 Diabetes Mellitus

et al. 2016

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BackgroundDue to population aging, an increasing number of elderly patients with diabetes use insulin. It is therefore important to investigate the characteristics of new insulins in this population. Faster-acting insulin aspart (faster aspart) is insulin aspart (IAsp) in a new formulation with faster absorption. This study investigated the pharmacological properties of faster aspart in elderly subjects with type 1 diabetes mellitus (T1DM).MethodsIn a randomised, double-blind, two-period crossover trial, 30 elderly (≥65 years) and 37 younger adults (18–35 years) with T1DM received single subcutaneous faster aspart or IAsp dosing (0.2 U/kg) and underwent an euglycaemic clamp (target 5.5 mmol/L) for up to 12 h.ResultsThe pharmacokinetic and pharmacodynamic time profiles were left-shifted for faster aspart versus IAsp. In each age group, onset of appearance occurred approximately twice as fast (~3 min earlier) and early exposure (area under the concentration–time curve [AUC] for serum IAsp from time zero to 30 min [AUCIAsp,0-30 min]) was greater (by 86% in elderly and 67% in younger adults) for faster aspart than for IAsp. Likewise, onset of action occurred 10 min faster in the elderly and 9 min faster in younger adults, and early glucose-lowering effect (AUC for the glucose infusion rate [GIR] from time zero to 30 min [AUCGIR,0-30 min]) was greater (by 109%) for faster aspart than for IAsp in both age groups. Total exposure (AUCIAsp,0-t) and the maximum concentration (C max) for faster aspart were greater (by 30 and 28%, respectively) in elderly than in younger adults. No age group differences were seen for the total (AUCGIR,0-t) or maximum (GIRmax) glucose-lowering effect.ConclusionThis study demonstrated that the ultra-fast pharmacological properties of faster aspart are similar in elderly subjects and younger adults with T1DM. ClinicalTrials.gov Identifier: NCT02003677.Electronic supplementary materialThe online version of this article (doi:10.1007/s40266-016-0418-6) contains supplementary material, which is available to authorized users.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 69%

Section: Discussionmentioning

confidence: 99%

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A Comparison of Pharmacokinetic and Pharmacodynamic Properties Between Faster-Acting Insulin Aspart and Insulin Aspart in Elderly Subjects with Type 1 Diabetes Mellitus

et al. 2016

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“…As the clinical pharmacology profiles of the IDeg and IAsp components of IDegAsp are distinct, evidence from PK and PD studies of IDeg and IAsp development programmes can be applied to IDegAsp. Moreover, no clinically relevant differences in the PDs of IDegAsp in older people were found following a phase 1, double-blind crossover trial of IDegAsp in young adults (18-35 years of age) and older (≥ 65 years of age) people with T1DM (22). In addition, no clinically relevant differences have been observed in the PK or PD of IDeg or IAsp in patients with renal or hepatic impairment (23)(24)(25).…”

Section: Pk/pd Properties Of Idegaspmentioning

confidence: 99%

Clinical use of the co-formulation of insulin degludec and insulin aspart

et al. 2016

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Summary Aims To provide a review of the available data and practical use of insulin degludec with insulin aspart (IDegAsp). Premixed insulins provide basal and prandial glucose control; however, they have an intermediate‐acting prandial insulin component and do not provide as effective basal coverage as true long‐acting insulins, owing to the physicochemical incompatibility of their individual components, coupled with the inflexibility of adjustment. The molecular structure of the co‐formulation of IDegAsp, a novel insulin preparation, allows these two molecules to coexist without affecting their individual pharmacodynamic profiles. Methods Clinical evidence in phase 2/3 trials of IDegAsp efficacy and safety in type 1 and type 2 diabetes mellitus (T1DM and T2DM) have been assessed and summarised. Results In people with T2DM, once‐ and twice‐daily dosing provides similar overall glycaemic control (HbA1c) to current modern insulins, but with lower risk of nocturnal hypoglycaemia. In prior insulin users, glycaemic control was achieved with lower or equal insulin doses vs. other basal+meal‐time or premix insulin regimens. In insulin‐naïve patients with T2DM, IDegAsp can be started once or twice‐daily, based on individual need. People switching from more than once‐daily basal or premix insulin therapy can be converted unit‐to‐unit to once‐daily IDegAsp, although this strategy should be assessed by the physician on an individual basis. Conclusions IDegAsp offers physicians and people with T2DM a simpler insulin regimen than other available basal‐bolus or premix‐based insulin regimens, with stable daytime basal coverage, a lower rate of hypoglycaemia and some flexibility in injection timing compared with premix insulins.

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Guideline for the Management of Diabetes Mellitus in the Elderly in China (2024 Edition)

Guo,

Xiao

2024

Aging Medicine

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With the deepening of aging in China, the prevalence of diabetes in older people has increased noticeably, and standardized diabetes management is critical for improving clinical outcomes of diabetes in older people. In 2021, the National Center of Gerontology, Chinese Society of Geriatrics, and Diabetes Professional Committee of Chinese Aging Well Association organized experts to write the first guideline for diabetes diagnosis and treatment in older people in China, the Guideline for the Management of Diabetes Mellitus in the Elderly in China (2021 Edition). The guideline emphasizes that older patients with diabetes are a highly heterogeneous group requiring comprehensive assessment and stratified and individualized management strategies. The guideline proposes simple treatments and de‐intensified treatment strategies for older patients with diabetes. This edition of the guideline provides clinicians with practical and operable clinical guidance, thus greatly contributing to the comprehensive and full‐cycle standardized management of older patients with diabetes in China and promoting the extensive development of clinical and basic research on diabetes in older people and related fields. In the past 3 years, evidence‐based medicine for older patients with diabetes and related fields has further advanced, and new treatment concepts, drugs, and technologies have been developed. The guideline editorial committee promptly updated the first edition of the guideline and compiled the Guideline for the Management of Diabetes Mellitus in the Elderly in China (2024 Edition). More precise management paths for older patients with diabetes are proposed, for achieving continued standardization of the management of older Chinese patients with diabetes and improving their clinical outcomes.

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The Distinct Prandial and Basal Pharmacodynamics of IDegAsp Observed in Younger Adults Are Preserved in Elderly Subjects with Type 1 Diabetes

Cited by 26 publications

References 13 publications

A Comparison of Pharmacokinetic and Pharmacodynamic Properties Between Faster-Acting Insulin Aspart and Insulin Aspart in Elderly Subjects with Type 1 Diabetes Mellitus

A Comparison of Pharmacokinetic and Pharmacodynamic Properties Between Faster-Acting Insulin Aspart and Insulin Aspart in Elderly Subjects with Type 1 Diabetes Mellitus

Clinical use of the co-formulation of insulin degludec and insulin aspart

Guideline for the Management of Diabetes Mellitus in the Elderly in China (2024 Edition)

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