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Greater early postprandial suppression of endogenous glucose production and higher initial glucose disappearance is achieved with fast-acting insulin aspart compared with insulin aspart.
Diabetes Obes Metab. 2018 07; 20(7):1615-1622.DO

Abstract

AIM

To investigate the mechanisms behind the lower postprandial glucose (PPG) concentrations achieved with fast-acting insulin aspart (faster aspart) than with insulin aspart (IAsp).

MATERIALS AND METHODS

In a randomized, double-blind, crossover trial, 41 people with type 1 diabetes received identical subcutaneous single faster aspart and IAsp doses (individualized for each participant), together with a standardized mixed meal (including 75 g carbohydrate labelled with [1-13 C] glucose). PPG turnover was determined by the triple-tracer meal method using continuous, variable [6-3 H] glucose and [6,6-2 H2 ] glucose infusion.

RESULTS

Insulin exposure within the first hour was 32% greater with faster aspart than with IAsp (treatment ratio faster aspart/IAsp 1.32 [95% confidence interval {CI} 1.18;1.48]; P < .001), leading to a 0.59-mmol/L non-significantly smaller PPG increment at 1 hour (ΔPG1h ; treatment difference faster aspart-IAsp -0.59 mmol/L [95% CI -1.19; 0.01]; P = .055). The trend towards reduced ΔPG1h with faster aspart was attributable to 12% greater suppression of endogenous glucose production (EGP; treatment ratio 1.12 [95% CI 1.01; 1.25]; P = .040) and 23% higher glucose disappearance (1.23 [95% CI 1.05; 1.45]; P = .012) with faster aspart than with IAsp during the first hour. Suppression of free fatty acid levels during the first hour was 36% greater for faster aspart than for IAsp (1.36 [95% CI 1.01;1.88]; P = .042).

CONCLUSIONS

The trend towards improved PPG control with faster aspart vs IAsp in this study was attributable to both greater early suppression of EGP and stimulation of glucose disappearance.

Authors+Show Affiliations

Division of Endocrinology, University of Virginia, Charlottesville, Virginia.Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria.Novo Nordisk, Søborg, Denmark.Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria.Novo Nordisk, Søborg, Denmark.Division of Endocrinology, University of Virginia, Charlottesville, Virginia.Novo Nordisk, Søborg, Denmark.

Pub Type(s)

Clinical Trial
Comparative Study
Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

29493118

Citation

Basu, Ananda, et al. "Greater Early Postprandial Suppression of Endogenous Glucose Production and Higher Initial Glucose Disappearance Is Achieved With Fast-acting Insulin Aspart Compared With Insulin Aspart." Diabetes, Obesity & Metabolism, vol. 20, no. 7, 2018, pp. 1615-1622.
Basu A, Pieber TR, Hansen AK, et al. Greater early postprandial suppression of endogenous glucose production and higher initial glucose disappearance is achieved with fast-acting insulin aspart compared with insulin aspart. Diabetes Obes Metab. 2018;20(7):1615-1622.
Basu, A., Pieber, T. R., Hansen, A. K., Sach-Friedl, S., Erichsen, L., Basu, R., & Haahr, H. (2018). Greater early postprandial suppression of endogenous glucose production and higher initial glucose disappearance is achieved with fast-acting insulin aspart compared with insulin aspart. Diabetes, Obesity & Metabolism, 20(7), 1615-1622. https://doi.org/10.1111/dom.13270
Basu A, et al. Greater Early Postprandial Suppression of Endogenous Glucose Production and Higher Initial Glucose Disappearance Is Achieved With Fast-acting Insulin Aspart Compared With Insulin Aspart. Diabetes Obes Metab. 2018;20(7):1615-1622. PubMed PMID: 29493118.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Greater early postprandial suppression of endogenous glucose production and higher initial glucose disappearance is achieved with fast-acting insulin aspart compared with insulin aspart. AU - Basu,Ananda, AU - Pieber,Thomas R, AU - Hansen,Ann K, AU - Sach-Friedl,Stefanie, AU - Erichsen,Lars, AU - Basu,Rita, AU - Haahr,Hanne, Y1 - 2018/03/30/ PY - 2018/01/09/received PY - 2018/02/23/revised PY - 2018/02/25/accepted PY - 2018/3/2/pubmed PY - 2018/12/18/medline PY - 2018/3/2/entrez KW - glucose metabolism KW - insulin therapy KW - pharmacodynamics KW - pharmacokinetics KW - type 1 diabetes KW - type 2 diabetes SP - 1615 EP - 1622 JF - Diabetes, obesity & metabolism JO - Diabetes Obes Metab VL - 20 IS - 7 N2 - AIM: To investigate the mechanisms behind the lower postprandial glucose (PPG) concentrations achieved with fast-acting insulin aspart (faster aspart) than with insulin aspart (IAsp). MATERIALS AND METHODS: In a randomized, double-blind, crossover trial, 41 people with type 1 diabetes received identical subcutaneous single faster aspart and IAsp doses (individualized for each participant), together with a standardized mixed meal (including 75 g carbohydrate labelled with [1-13 C] glucose). PPG turnover was determined by the triple-tracer meal method using continuous, variable [6-3 H] glucose and [6,6-2 H2 ] glucose infusion. RESULTS: Insulin exposure within the first hour was 32% greater with faster aspart than with IAsp (treatment ratio faster aspart/IAsp 1.32 [95% confidence interval {CI} 1.18;1.48]; P < .001), leading to a 0.59-mmol/L non-significantly smaller PPG increment at 1 hour (ΔPG1h ; treatment difference faster aspart-IAsp -0.59 mmol/L [95% CI -1.19; 0.01]; P = .055). The trend towards reduced ΔPG1h with faster aspart was attributable to 12% greater suppression of endogenous glucose production (EGP; treatment ratio 1.12 [95% CI 1.01; 1.25]; P = .040) and 23% higher glucose disappearance (1.23 [95% CI 1.05; 1.45]; P = .012) with faster aspart than with IAsp during the first hour. Suppression of free fatty acid levels during the first hour was 36% greater for faster aspart than for IAsp (1.36 [95% CI 1.01;1.88]; P = .042). CONCLUSIONS: The trend towards improved PPG control with faster aspart vs IAsp in this study was attributable to both greater early suppression of EGP and stimulation of glucose disappearance. SN - 1463-1326 UR - https://www.unboundmedicine.com/medline/citation/29493118/Greater_early_postprandial_suppression_of_endogenous_glucose_production_and_higher_initial_glucose_disappearance_is_achieved_with_fast_acting_insulin_aspart_compared_with_insulin_aspart_ L2 - https://doi.org/10.1111/dom.13270 DB - PRIME DP - Unbound Medicine ER -