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Comparable Glucose Control with Fast-Acting Insulin Aspart Versus Insulin Aspart Using a Second-Generation Hybrid
Dale Morrison1, Dessi P Zaharieva2, Melissa H Lee1,3
1Department of Medicine, University of Melbourne, Melbourne, Australia.
Diabetes Technology & Therapeutics
|September 15, 2021
Summary
Fast-acting insulin aspart (FiAsp) and standard insulin aspart showed no difference in glucose control during and after exercise using a closed-loop system. Future insulin formulations need greater offset for improved exercise glucose management in type 1 diabetes.
Area of Science:
- Endocrinology
- Metabolic Diseases
- Exercise Physiology
Background:
- Type 1 diabetes (T1D) management requires careful glucose monitoring, especially during physical activity.
- Exercise, both moderate-intensity (MIE) and high-intensity (HIE), significantly impacts glycemic control in individuals with T1D.
- Closed-loop (CL) insulin delivery systems aim to automate glucose regulation, but exercise poses a challenge.
Purpose of the Study:
- To compare the efficacy of fast-acting insulin aspart (FiAsp) versus standard insulin aspart in maintaining glucose control during and after MIE and HIE within a second-generation CL system.
- To evaluate the time in range (TIR) and time spent in hypoglycemia and hyperglycemia following different exercise protocols with two insulin formulations.
Main Methods:
- A randomized crossover study involving 16 adults with T1D.
- Participants used a MiniMed™ Advanced hybrid CL system with either FiAsp or insulin aspart for 6-week periods.
- Four exercise sessions (MIE and HIE) were performed in random order within each period, with glucose monitored continuously.
Main Results:
- No significant differences in 24-hour TIR, time in hypoglycemia, or time in hyperglycemia were observed between FiAsp and insulin aspart for both MIE and HIE.
- TIR approached 100% within 2 hours post-exercise and overnight across all conditions.
- The study found no improvement in CL glucose control with FiAsp compared to standard insulin aspart during or after exercise.
Conclusions:
- Current insulin formulations, including FiAsp, do not offer a significant advantage over standard insulin aspart for glucose control with exercise in a second-generation CL system.
- Development of insulin formulations with a greater offset in action is necessary to enhance CL system performance during physical activity in T1D.
- Further research is needed to optimize insulin delivery strategies for exercise in automated insulin delivery systems.
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