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Fast-Acting Insulin Aspart and the Need for New Mealtime Insulin Analogues in Adults With Type 1 and Type 2 Diabetes: A Canadian Perspective.
Can J Diabetes 2019; 43(7):515-523CJ

Abstract

Limiting postprandial glucose (PPG) excursions is an important aspect of overall glycemic control. Rapid-acting insulin analogues (RAIAs) aim to mimic the physiologic action of endogenous insulin observed in individuals without diabetes and prevent excessive PPG excursions. However, many people with type 1 diabetes and type 2 diabetes treated with RAIAs do not achieve glycated hemoglobin (A1C) targets, and there is an unmet need for further improvements in PPG control. Current RAIAs have a delayed onset and a longer duration of action compared with endogenous insulin secreted in response to meals. Approaches to developing new mealtime insulins with accelerated absorption kinetics include changing the route of administration (i.e. via inhalation) and changing the insulin formulation. Fast-acting insulin aspart (faster aspart) is a novel formulation of insulin aspart (IAsp) containing the excipients niacinamide and L-arginine. Faster aspart has an earlier onset of insulin exposure and a greater early glucose-lowering effect than IAsp. In large clinical trials, mealtime faster aspart demonstrated noninferiority to IAsp with respect to A1C reduction and provided superior PPG control with no increase in overall severe or blood glucose-confirmed hyperglycemia. In addition, faster aspart administered up to 20 min after the start of a meal was noninferior to mealtime IAsp in terms of A1C control, highlighting the opportunity for postmeal dosing. Faster aspart is the first of a new generation of mealtime insulins to be approved in Canada for the treatment of adults with type 1 diabetes and type 2 diabetes, and it is included in the 2018 Diabetes Canada clinical practice guidelines.

Authors+Show Affiliations

Division of Endocrinology and Metabolism, University of Alberta, Edmonton, Alberta, Canada. Electronic address: psenior@ualberta.ca.Division of Endocrinology and Metabolism, Western University, London, Ontario, Canada.

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

30872107

Citation

Senior, Peter, and Irene Hramiak. "Fast-Acting Insulin Aspart and the Need for New Mealtime Insulin Analogues in Adults With Type 1 and Type 2 Diabetes: a Canadian Perspective." Canadian Journal of Diabetes, vol. 43, no. 7, 2019, pp. 515-523.
Senior P, Hramiak I. Fast-Acting Insulin Aspart and the Need for New Mealtime Insulin Analogues in Adults With Type 1 and Type 2 Diabetes: A Canadian Perspective. Can J Diabetes. 2019;43(7):515-523.
Senior, P., & Hramiak, I. (2019). Fast-Acting Insulin Aspart and the Need for New Mealtime Insulin Analogues in Adults With Type 1 and Type 2 Diabetes: A Canadian Perspective. Canadian Journal of Diabetes, 43(7), pp. 515-523. doi:10.1016/j.jcjd.2019.01.004.
Senior P, Hramiak I. Fast-Acting Insulin Aspart and the Need for New Mealtime Insulin Analogues in Adults With Type 1 and Type 2 Diabetes: a Canadian Perspective. Can J Diabetes. 2019;43(7):515-523. PubMed PMID: 30872107.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Fast-Acting Insulin Aspart and the Need for New Mealtime Insulin Analogues in Adults With Type 1 and Type 2 Diabetes: A Canadian Perspective. AU - Senior,Peter, AU - Hramiak,Irene, Y1 - 2019/01/24/ PY - 2018/09/18/received PY - 2018/12/06/revised PY - 2019/01/16/accepted PY - 2019/3/16/pubmed PY - 2019/3/16/medline PY - 2019/3/16/entrez KW - analogue de l'insuline à action rapide KW - aspart KW - asparte KW - diabète de type 1 KW - diabète de type 2 KW - fast-acting insulin KW - glycémie postprandiale KW - insuline à action rapide KW - postprandial glucose KW - rapid-acting insulin analogue KW - type 1 diabetes KW - type 2 diabetes SP - 515 EP - 523 JF - Canadian journal of diabetes JO - Can J Diabetes VL - 43 IS - 7 N2 - Limiting postprandial glucose (PPG) excursions is an important aspect of overall glycemic control. Rapid-acting insulin analogues (RAIAs) aim to mimic the physiologic action of endogenous insulin observed in individuals without diabetes and prevent excessive PPG excursions. However, many people with type 1 diabetes and type 2 diabetes treated with RAIAs do not achieve glycated hemoglobin (A1C) targets, and there is an unmet need for further improvements in PPG control. Current RAIAs have a delayed onset and a longer duration of action compared with endogenous insulin secreted in response to meals. Approaches to developing new mealtime insulins with accelerated absorption kinetics include changing the route of administration (i.e. via inhalation) and changing the insulin formulation. Fast-acting insulin aspart (faster aspart) is a novel formulation of insulin aspart (IAsp) containing the excipients niacinamide and L-arginine. Faster aspart has an earlier onset of insulin exposure and a greater early glucose-lowering effect than IAsp. In large clinical trials, mealtime faster aspart demonstrated noninferiority to IAsp with respect to A1C reduction and provided superior PPG control with no increase in overall severe or blood glucose-confirmed hyperglycemia. In addition, faster aspart administered up to 20 min after the start of a meal was noninferior to mealtime IAsp in terms of A1C control, highlighting the opportunity for postmeal dosing. Faster aspart is the first of a new generation of mealtime insulins to be approved in Canada for the treatment of adults with type 1 diabetes and type 2 diabetes, and it is included in the 2018 Diabetes Canada clinical practice guidelines. SN - 2352-3840 UR - https://www.unboundmedicine.com/medline/citation/30872107/Fast_Acting_Insulin_Aspart_and_the_Need_for_New_Mealtime_Insulin_Analogues_in_Adults_With_Type_1_and_Type_2_Diabetes:_A_Canadian_Perspective_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1499-2671(18)30804-9 DB - PRIME DP - Unbound Medicine ER -